1184680795 NPI number — DR. ROBERT A. OLDER M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184680795 NPI number — DR. ROBERT A. OLDER M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

OLDER

Provider First Name:

ROBERT

Provider Middle Name:

A.

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1184680795

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

9105 STONY POINT PKWY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

RICHMOND

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23235-1979

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

9105 STONY POINT PKWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

RICHMOND

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23235-1979

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

804-287-1030

Provider Business Practice Location Address Fax Number:

804-288-3529

Provider Enumeration Date:

04/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  0101 020136 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 64186 . This is a "SENTARA FAMILY CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 8036132 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 2137661 . This is a "ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 299905 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 53223 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: CA4541 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: C06623 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: P00175475 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1053721 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1603383 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 5475270 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".