Basic Information
| Provider Information | |||||||||
| NPI: | 1083742621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONALD | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6020 RICHMOND HWY | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223032157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433933653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1141 ELDEN ST | ||||||||
| Address2: | THIRD FLOOR | ||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201705549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034818160 | ||||||||
| FaxNumber: | 7034356752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0102202462 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1083742621 | 05 | VA | MEDICAID |