Provider Demographics
NPI:1700858776
Name:SURRATT, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:SURRATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1085 NE GATEWAY CT
Mailing Address - Street 2:SUITE 200, ARDSLEY INTERNAL MEDICINE
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2406
Mailing Address - Country:US
Mailing Address - Phone:704-260-8650
Mailing Address - Fax:704-260-8665
Practice Address - Street 1:1085 NE GATEWAY CT
Practice Address - Street 2:SUITE 200, ARDSLEY INTERNAL MEDICINE
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2406
Practice Address - Country:US
Practice Address - Phone:704-260-8650
Practice Address - Fax:704-260-8665
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC25087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC31489OtherMEDCOST
NC4324723OtherAETNA ID
NC111011OtherWELLPATH
NC81014OtherBCBS ID
NC298677OtherMAMSI
NC110220835OtherRAILROAD MEDICARE ID
NC232009OtherMEDICARE-OTHER
NC566000156OtherPRACTICE TAX ID
NC5246OtherPARTNERS MEDICARE CH
NC8981014Medicaid
NCC86659Medicare UPIN
NC566000156OtherPRACTICE TAX ID