Provider Demographics
NPI:1225130891
Name:PRINCE, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:PRINCE
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 918
Mailing Address - Street 2:1035 CHERAW ST.
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-0918
Mailing Address - Country:US
Mailing Address - Phone:843-454-0841
Mailing Address - Fax:843-454-0635
Practice Address - Street 1:207 COMMERCE AVE.
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-0000
Practice Address - Country:US
Practice Address - Phone:843-623-2229
Practice Address - Fax:843-623-2553
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120052084P0800X, 208D00000X
SC40072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC69225OtherBCBS
NC477030OtherHUMANA GOLD CHOICE
NC5906238Medicaid
NCAP0343676OtherDEA
NC69225OtherBCBS