MEDICARE: ROBERT J MEALY,III.P.C.

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
1	1223G0001X	General Practice Dentistry	0401005058	VA

General Provider Information

NPI Number	:	1649443706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT J MEALY,III.P.C.

Provider Business Mailing Address
First Line	:	2737 CAMPOSTELLA RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-3656
Country	:	US
Telephone Number	:	757-543-7973
Fax Number	:	757-543-7926

Provider Business Practice Location Address
First Line	:	2737 CAMPOSTELLA RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-3656
Country	:	US
Telephone Number	:	757-543-7973
Fax Number	:	757-543-7926

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT JAMES MEALY III
Credential	:	DDS
Telephone Number	:	757-543-7973

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	04/10/2008

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