Healthcare Provider Details

I. General information

NPI: 1366524183
Provider Name (Legal Business Name): ROBERT EDMUND MORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N GEORGE MASON DR SUITE 204
ARLINGTON VA
22205-3609
US

IV. Provider business mailing address

10108 S GLEN RD
POTOMAC MD
20854-4132
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-7476
  • Fax: 703-528-4209
Mailing address:
  • Phone: 703-217-1621
  • Fax: 301-299-1712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101025911
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: