Healthcare Provider Details

I. General information

NPI: 1801812334
Provider Name (Legal Business Name): ROBIN VIRGIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN WORRELL MD

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 230
EUGENE OR
97401-8122
US

IV. Provider business mailing address

16811 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-3404
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-6010
  • Fax: 458-205-6072
Mailing address:
  • Phone: 360-735-8100
  • Fax: 360-735-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00035434
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD218382
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20270
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8213811
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: