Provider Demographics
NPI:1659785574
Name:ROBINSON, ISRAEL (DCA)
Entity Type:Individual
Prefix:MR
First Name:ISRAEL
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-3414
Mailing Address - Country:US
Mailing Address - Phone:864-279-7120
Mailing Address - Fax:864-699-9775
Practice Address - Street 1:2313 BRUCE AVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-3414
Practice Address - Country:US
Practice Address - Phone:864-279-7120
Practice Address - Fax:864-699-9775
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCB0002871171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC247200000XMedicaid