Provider Demographics
NPI:1518091081
Name:DIMITRIOUS, ROBIN ZAKI (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ZAKI
Last Name:DIMITRIOUS
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 505
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-0505
Mailing Address - Country:US
Mailing Address - Phone:910-642-6427
Mailing Address - Fax:910-642-5769
Practice Address - Street 1:500 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3634
Practice Address - Country:US
Practice Address - Phone:910-642-6427
Practice Address - Fax:910-642-5769
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23511207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7928638Medicaid
NC202236CMedicare ID - Type UnspecifiedROBIN DIMITRIOUS, M.D.
NC7928638Medicaid