Provider Demographics
NPI:1063450609
Name:LOCKE, ROBERT G (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:LOCKE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:4745 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 217 MEDICAL ARTS PAVILION ONE
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-733-2374
Mailing Address - Fax:302-733-2602
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 217 MEDICAL ARTS PAVILION ONE
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-733-2374
Practice Address - Fax:302-733-2602
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-05-24
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Provider Licenses
StateLicense IDTaxonomies
DEC200050602080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000794503Medicaid
F02936Medicare UPIN