Basic Information
| Provider Information | |||||||||
| NPI: | 1689627911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | D'HAEM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 KINGSLEY LN | ||||||||
| Address2: | STE 305 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895422 | ||||||||
| FaxNumber: | 7578895450 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 KINGSLEY LN | ||||||||
| Address2: | STE 305 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895422 | ||||||||
| FaxNumber: | 7578895450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 12/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 0101034370 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300043436 | 01 | VA | RAILROAD MEDICARE | OTHER | 007238878 | 05 | VA | MEDICAID |