Provider Demographics
NPI:1821077355
Name:PATTILLO, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:PATTILLO
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 1:211 S MAIN ST
Mailing Address - Street 2:STE 205
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2264
Mailing Address - Country:US
Mailing Address - Phone:609-463-0800
Mailing Address - Fax:609-463-0957
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2264
Practice Address - Country:US
Practice Address - Phone:609-463-0800
Practice Address - Fax:609-463-0957
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049479L207RA0001X
NJ25MA09809000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1473916Medicaid
PA1473916Medicaid
527682Medicare ID - Type Unspecified