Provider Demographics
NPI:1245359728
Name:MCCAMMON, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MCCAMMON
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 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3253
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:1400 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4655
Practice Address - Country:US
Practice Address - Phone:704-845-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC307242085R0001X
NC2008-007342085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC207283OtherMEDCOST
NC5909249Medicaid
SCN0073DMedicaid
NC2022175Medicare PIN
NC2022175CMedicare PIN
NC2022175AMedicare PIN
SCAA27776058Medicare PIN
NC2022175BMedicare PIN