Provider Demographics
NPI:1467434134
Name:AGNELLO, ROBERT NICHOLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NICHOLAS
Last Name:AGNELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SPRING POND LN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9328
Mailing Address - Country:US
Mailing Address - Phone:910-813-5391
Mailing Address - Fax:
Practice Address - Street 1:129 TT LANIER STREET
Practice Address - Street 2:
Practice Address - City:BUIES CREEK
Practice Address - State:NC
Practice Address - Zip Code:27506
Practice Address - Country:US
Practice Address - Phone:910-893-1560
Practice Address - Fax:910-814-5727
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00474208VP0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI09554Medicare UPIN