Healthcare Provider Details

I. General information

NPI: 1932186822
Provider Name (Legal Business Name): ASHBY ROBERT TRUNDLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 E JEFFERSON ST
CHARLOTTESVILLE VA
22902-5354
US

IV. Provider business mailing address

3062 BEAUMONT FARM RD
CHARLOTTESVILLE VA
22901-8705
US

V. Phone/Fax

Practice location:
  • Phone: 434-296-9161
  • Fax: 434-296-1036
Mailing address:
  • Phone: 434-979-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234677
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: