Provider Demographics
NPI:1689670036
Name:MCCALL, ROBERT DONNELL JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DONNELL
Last Name:MCCALL
Suffix:JR
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 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:110 DENNIS DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6343
Practice Address - Country:US
Practice Address - Phone:919-774-4511
Practice Address - Fax:919-774-3196
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33546207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955676Medicaid
NC8955676Medicaid
NCNCL624AMedicare PIN
213566AMedicare ID - Type Unspecified
C73711Medicare UPIN
NC2381170Medicare PIN