Provider Demographics
NPI:1164630984
Name:CONKLIN, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:CONKLIN
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 1987
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1987
Mailing Address - Country:US
Mailing Address - Phone:828-213-0594
Mailing Address - Fax:828-213-9149
Practice Address - Street 1:222 ASHELAND AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4016
Practice Address - Country:US
Practice Address - Phone:828-213-0594
Practice Address - Fax:828-213-9149
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-005402085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA434625918AMedicaid
SCQ0054TMedicaid
NC155X4OtherBCBS NC
NC5913346Medicaid
NC2073821Medicare PIN
NC5913346Medicaid