Provider Demographics
NPI:1922049105
Name:BOHL, ROBERT DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:BOHL
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 1:222 VIRGINIA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-9667
Mailing Address - Country:US
Mailing Address - Phone:252-482-2210
Mailing Address - Fax:252-482-2257
Practice Address - Street 1:222 VIRGINIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9667
Practice Address - Country:US
Practice Address - Phone:252-482-2210
Practice Address - Fax:252-482-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00196208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910769Medicaid
OH0355246OtherRAILROAD MEDICARE
OH0355246OtherRAILROAD MEDICARE
NC2023404Medicare PIN