Provider Demographics
NPI:1154306405
Name:HENDEL, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:HENDEL
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 1:87 MEDICAL PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3874
Mailing Address - Country:US
Mailing Address - Phone:828-884-2198
Mailing Address - Fax:828-862-5328
Practice Address - Street 1:87 MEDICAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3874
Practice Address - Country:US
Practice Address - Phone:828-884-2198
Practice Address - Fax:828-862-5328
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23557174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8941364Medicaid
NC8941364Medicaid
NCC81091Medicare UPIN