Provider Demographics
NPI:1851359749
Name:MOTHERSHED, ROBB ASHLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBB
Middle Name:ASHLEY
Last Name:MOTHERSHED
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-765-0710
Mailing Address - Fax:336-765-0821
Practice Address - Street 1:3057 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3220
Practice Address - Country:US
Practice Address - Phone:336-765-0710
Practice Address - Fax:336-765-0821
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC373213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC373OtherLICENSE
NCP00368266OtherRR MEDICARE
NC890803XMedicaid
NCU70150Medicare UPIN
NCP00368266OtherRR MEDICARE
NC2433219AMedicare PIN