Provider Demographics
NPI:1629068036
Name:GO, ROBIN ONG (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ONG
Last Name:GO
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 2500
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4201
Practice Address - Country:US
Practice Address - Phone:864-585-5433
Practice Address - Fax:864-591-4053
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500596207K00000X
SC19036207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12964OtherAETNA
SC10068821OtherAMERIGROUP
SC190368Medicaid
NC12964OtherBLUE CROSS BLUE SHIELD
SCA1339OtherMEDCOST
SCP01505892OtherRAILROAD MEDICARE
NC8912964Medicaid
SCSC54036084OtherMEDICARE PIN
SC190368Medicaid
SCA1339OtherMEDCOST
NC12964OtherBLUE CROSS BLUE SHIELD
G56868Medicare UPIN
SCG568684292Medicare PIN