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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