Basic Information
| Provider Information | |||||||||
| NPI: | 1871948125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERDMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ZACHARY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 102222 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303682222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392748200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4689 US HIGHWAY 17 STE 2-5 | ||||||||
| Address2: | |||||||||
| City: | FLEMING ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320034831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042696526 | ||||||||
| FaxNumber: | 9042696527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2016 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | ME157835 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | ME157835 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.