Provider Demographics
NPI:1528032687
Name:QUALHEIM, ROBERT EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EVERETT
Last Name:QUALHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1321 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2303
Mailing Address - Country:US
Mailing Address - Phone:336-530-4491
Mailing Address - Fax:949-561-5143
Practice Address - Street 1:1321 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2303
Practice Address - Country:US
Practice Address - Phone:336-530-4491
Practice Address - Fax:949-561-5143
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28557207P00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C76961Medicare UPIN
NC209760CMedicare ID - Type Unspecified