Organization
OMALLEY FOOT AND ANKLE PA
Active
Organization
OMALLEY FOOT AND ANKLE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BRIAN OMALLEY DPM (PRESIDENTOWNER)
(910) 251-9880
Entity
Organization
Contact information
Practice address
1505 MEDICAL CENTER DR, WILMINGTON, NC 28401-7507
(910) 251-9880
(910) 251-9297
Mailing address
1505 MEDICAL CENTER DR, WILMINGTON, NC 28401-7507
(910) 251-9880
(910) 251-9297
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
418
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018H0
BCBS-NC
NC
01
—
1284510001
MEDICARE DMERC PTAN
NC
05
—
790801M
—
NC
Enumeration date
09/21/2006
Last updated
10/05/2011
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