Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 2020-02231 | NC |
NPI | 1346504297 |
---|---|
Provider Name | Robert Tillman |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28203-5866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 20/01/2021 |