Healthcare Provider Details

I. General information

NPI: 1285876953
Provider Name (Legal Business Name): WILLIAM JOSEPH ROBERTS JR. CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 HANBURY RD E SUITE 17 #242
CHESAPEAKE VA
23322-6621
US

IV. Provider business mailing address

237 HANBURY RD E SUITE 17 #242
CHESAPEAKE VA
23322-6621
US

V. Phone/Fax

Practice location:
  • Phone: 757-630-0155
  • Fax:
Mailing address:
  • Phone: 757-630-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: