Basic Information
| Provider Information | |||||||||
| NPI: | 1235111899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERT | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1088 LONDON LINKS DR | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245514662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345346868 | ||||||||
| FaxNumber: | 4345348808 | ||||||||
| Practice Location | |||||||||
| Address1: | 1088 LONDON LINKS DR | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245514662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345346868 | ||||||||
| FaxNumber: | 4345348808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101055355 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080126143 | 01 | MEDICARE RAILROAD PROVIDER NUMBER | OTHER | 005635683 | 05 | VA | MEDICAID | 197357 | 01 | ANTHEM | OTHER |