Provider Demographics
NPI:1184225724
Name:CONYER, ROBERT CHARLEA III
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHARLEA
Last Name:CONYER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CEDAR ST SE APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5013
Mailing Address - Country:US
Mailing Address - Phone:202-381-6928
Mailing Address - Fax:
Practice Address - Street 1:1441 CEDAR ST SE APT 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5013
Practice Address - Country:US
Practice Address - Phone:202-381-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3253676376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide