Provider Demographics
NPI:1447234588
Name:NANTAIS, ROBERT PAUL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:NANTAIS
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11530 PROVIDENCE RD
Practice Address - Street 2:STE 1300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2691
Practice Address - Country:US
Practice Address - Phone:704-667-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00029207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373338600Medicaid
0656500OtherAETNA
NC1447234588Medicaid
200014900OtherRR MEDICARE
NCNCF595BMedicare PIN
FL23135Medicare PIN
NCNCF595AMedicare PIN
NC1447234588Medicaid