Provider Demographics
NPI:1841358058
Name:O'SULLIVAN, ROBERT KELLY (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KELLY
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:PA-C
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:CHERRY HOSPITAL
Mailing Address - Street 2:1401 WEST ASH STREET
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-1078
Mailing Address - Country:US
Mailing Address - Phone:919-947-8252
Mailing Address - Fax:919-705-5140
Practice Address - Street 1:CHERRY HOSPITAL
Practice Address - Street 2:1401 WEST ASH STREET
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1078
Practice Address - Country:US
Practice Address - Phone:919-947-8252
Practice Address - Fax:919-705-5140
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-02243363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762465Medicare PIN