1770548109 NPI number — CHERYL K ROBSON OD

Table of content: CHERYL K ROBSON OD (NPI 1770548109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770548109 NPI number — CHERYL K ROBSON OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBSON
Provider First Name:
CHERYL
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KANE
Provider Other First Name:
CHERYL
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770548109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 CEDAR CREEK GRADE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-665-0541
Provider Business Mailing Address Fax Number:
540-665-8286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 CEDAR CREEK GRADE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-665-0541
Provider Business Practice Location Address Fax Number:
540-665-8286
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618000117 , 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: 6191460001 . This is a "MEDICARE DME" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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