Provider Demographics
NPI:1104820133
Name:MCCONVILLE, ROBERT HOWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HOWARD
Last Name:MCCONVILLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1125 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4162
Mailing Address - Country:US
Mailing Address - Phone:919-774-6023
Mailing Address - Fax:919-776-6359
Practice Address - Street 1:1125 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4162
Practice Address - Country:US
Practice Address - Phone:919-774-6023
Practice Address - Fax:919-776-6359
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC20316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC412013354OtherRR MEDICARE
NC0138851OtherUNITED HEALTHCARE
NC270326OtherMAMSI
NC133545617OtherTRICARE
NC8955856Medicaid
NC3913OtherPARTNERS
NC27772OtherMEDCOST
NC55856OtherBCBS
208654Medicare PIN
NC412013354OtherRR MEDICARE