Provider Demographics
NPI:1891287934
Name:ECKENSWEILER, ROBERT JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:ECKENSWEILER
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 1:267 S CHURTON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2695
Mailing Address - Country:US
Mailing Address - Phone:919-732-8131
Mailing Address - Fax:
Practice Address - Street 1:267 S CHURTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2695
Practice Address - Country:US
Practice Address - Phone:919-732-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-07-18
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-02-10
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2021-01044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program