Provider Demographics
NPI:1508889643
Name:RASPA, ROBERT PASQUALE (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PASQUALE
Last Name:RASPA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:15825 JOHN J DELANEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3146
Practice Address - Country:US
Practice Address - Phone:704-323-3410
Practice Address - Fax:704-323-3402
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00078500363AS0400X
NC0010-02781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicaid
NCPENDINGMedicare PIN
NJ073344PFCMedicare ID - Type Unspecified
NJP00344400Medicare PIN