Provider Demographics
NPI:1194881888
Name:MCAULEY, ROBERT ADDISON (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ADDISON
Last Name:MCAULEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:729 SUNRISE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4504
Mailing Address - Country:US
Mailing Address - Phone:916-781-7882
Mailing Address - Fax:916-781-3787
Practice Address - Street 1:729 SUNRISE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4504
Practice Address - Country:US
Practice Address - Phone:916-781-7882
Practice Address - Fax:916-781-3787
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23317208100000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM1818357OtherDEA
CAF65684Medicare UPIN