Provider Demographics
NPI:1366631640
Name:ROBERT JOSEPH HEALY MD PA
Entity Type:Organization
Organization Name:ROBERT JOSEPH HEALY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-664-9200
Mailing Address - Street 1:805 PAMPLICO HWY
Mailing Address - Street 2:SUITE A130
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6019
Mailing Address - Country:US
Mailing Address - Phone:843-664-9200
Mailing Address - Fax:843-664-9202
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:SUITE A130
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6019
Practice Address - Country:US
Practice Address - Phone:843-664-9200
Practice Address - Fax:843-664-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC111782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC4802Medicaid
SC130002489OtherMEDICARE RAILROAD
SCPC4802Medicaid