1326248584 NPI number — ROBERT W. DECONTI, M.D., INC.

Table of content: (NPI 1326248584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326248584 NPI number — ROBERT W. DECONTI, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT W. DECONTI, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326248584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7229 FOREST AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-3765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-673-8000
Provider Business Mailing Address Fax Number:
804-673-4067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7229 FOREST AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-673-8000
Provider Business Practice Location Address Fax Number:
804-673-4067
Provider Enumeration Date:
07/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DECONTI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
804-673-8000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101051435 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6900275 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".