Healthcare Provider Details

I. General information

NPI: 1003103698
Provider Name (Legal Business Name): ROBERT MINH CAO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 N SCOTT ST APT 639
ARLINGTON VA
22209-1344
US

IV. Provider business mailing address

1860 N SCOTT ST APT 639
ARLINGTON VA
22209-1344
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-9256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125063983
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD045982
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD045982
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: