Provider Demographics
NPI:1083672745
Name:CAIN, ROBERT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:CAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:615 WESLEY DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-266-4400
Practice Address - Fax:843-577-0455
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110232038OtherRAILROAD MEDICARE
SCP00754359OtherRAILROAD MC ID-RSPN
SC110175765OtherRAILROAD MEDICARE
SCTL2039Medicaid
SCTL2039Medicaid
SC1497874424Medicare PIN
SC110175765OtherRAILROAD MEDICARE
SC1235180571Medicare PIN
SCD176304943Medicare PIN
SCD176306795Medicare PIN