Provider Demographics
NPI:1619929973
Name:DIMEGLIO, ROBERT V (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:DIMEGLIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1930 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-284-4040
Mailing Address - Fax:678-284-4076
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:STE 6025
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-352-9260
Practice Address - Fax:404-352-9187
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA042231208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000727823HMedicaid
GA000727823GMedicaid
GA000727823HMedicaid
GA202I213457Medicare PIN