Provider Demographics
NPI:1013072305
Name:AVERY, ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:AVERY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:THE WANAMAKER BLDG 9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9538
Mailing Address - Fax:267-425-9552
Practice Address - Street 1:34TH & CIVIC CENTER BLVD
Practice Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-590-2791
Practice Address - Fax:215-590-4325
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-11-20
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Provider Licenses
StateLicense IDTaxonomies
PAOT0106412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology