Provider Demographics
NPI:1659369155
Name:ATWELL, ROBERT A (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ATWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 COSHOCTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1900
Mailing Address - Country:US
Mailing Address - Phone:740-397-4262
Mailing Address - Fax:740-392-8257
Practice Address - Street 1:809 COSHOCTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1900
Practice Address - Country:US
Practice Address - Phone:740-397-4262
Practice Address - Fax:740-392-8257
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001945213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479591Medicare PIN
OH5061230001Medicare NSC
OHT80488Medicare UPIN