Provider Demographics
NPI:1417477423
Name:TISHERMAN, ROBERT THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THEODORE
Last Name:TISHERMAN
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 1:3475 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-0005
Mailing Address - Country:US
Mailing Address - Phone:919-660-1949
Mailing Address - Fax:
Practice Address - Street 1:100 DUKE HEALTH CARY PL STE 120
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6760
Practice Address - Country:US
Practice Address - Phone:919-858-1203
Practice Address - Fax:919-385-9500
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-01074207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine