Provider Demographics
NPI:1275652067
Name:ROUCHARD-PLASSER, ROBIN ANN (PA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ANN
Last Name:ROUCHARD-PLASSER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-9440
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-9440
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101371363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2747378BMedicare PIN