Provider Demographics
NPI:1619037041
Name:ROBINSON, PEGGY JO (PA-C)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:ROBINSON
Suffix:
Gender:F
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 1:1728 FORDHAM BLVD
Mailing Address - Street 2:151 RAM'S PLAZA
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2397
Mailing Address - Country:US
Mailing Address - Phone:919-968-1985
Mailing Address - Fax:919-942-0038
Practice Address - Street 1:1728 FORDHAM BLVD
Practice Address - Street 2:151 RAM'S PLAZA
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2397
Practice Address - Country:US
Practice Address - Phone:919-968-1985
Practice Address - Fax:919-942-0038
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101578363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101578OtherMEDICAL LICENSE
NCS72483Medicare UPIN