Provider Demographics
NPI:1194724245
Name:PALERINO, ROBERT G (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:PALERINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7141 MOON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7294
Mailing Address - Country:US
Mailing Address - Phone:706-257-9998
Mailing Address - Fax:706-257-9993
Practice Address - Street 1:7141 MOON RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7294
Practice Address - Country:US
Practice Address - Phone:706-257-9998
Practice Address - Fax:706-257-9993
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22677207Q00000X
GA028848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00366132GMedicaid
GAP00341620OtherRAILROAD MEDICARE
AL009928700Medicaid
GA1194724245OtherNPI
GA000366132GMedicaid
AL000096040Medicare PIN