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NPI Code Detail

MEDICARE: MR. ROBERT REID NOTTINGHAM JR. CSA

MEDICARE: MR. ROBERT REID NOTTINGHAM JR. CSA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZC0007XSurgical Assistant5016VA
2363AS0400XSurgical Physician AssistantVA

General Provider Information

NPI Number : 1164080321
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT REID NOTTINGHAM JR. CSA
Provider Business Mailing Address
First Line : 2300 WILSON BLVD STE 700
Second Line :
City : ARLINGTON
State : VA
Zip : 22201-5435
Country : US
Telephone Number : 757-439-0033
Fax Number :
Provider Business Practice Location Address
First Line : 2300 WILSON BLVD STE 700
Second Line :
City : ARLINGTON
State : VA
Zip : 22201-5435
Country : US
Telephone Number : 757-439-0033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2019
Last Update Date : 06/05/2023

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