Provider Demographics
NPI:1497860159
Name:ORNELAS, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:ORNELAS
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 1:214 LEVENTIS LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3962
Mailing Address - Country:US
Mailing Address - Phone:803-808-4441
Mailing Address - Fax:
Practice Address - Street 1:160 MEDICAL CIR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3612
Practice Address - Country:US
Practice Address - Phone:803-796-6811
Practice Address - Fax:803-796-6851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC233762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC233768Medicaid
SCAA11203353Medicare PIN
SC233768Medicaid
SCI43195Medicare UPIN