Healthcare Provider Details

I. General information

NPI: 1073607941
Provider Name (Legal Business Name): ROBERT A DRYDEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SAM PERRY BLVD MARY WASHINGTON HOSPITAL EMERGENCY DEPARTMENT
FREDERICKSBURG VA
22401-4453
US

IV. Provider business mailing address

PO BOX 888
FREDERICKSBURG VA
22404-0888
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-1167
  • Fax: 540-741-1164
Mailing address:
  • Phone: 866-898-7138
  • Fax: 616-975-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840524
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: