Healthcare Provider Details

I. General information

NPI: 1740386911
Provider Name (Legal Business Name): ROBERT E KANE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10632 TOSTON LN
GLEN ALLEN VA
23060-6498
US

IV. Provider business mailing address

10632 TOSTON LN
GLEN ALLEN VA
23060-6498
US

V. Phone/Fax

Practice location:
  • Phone: 804-475-2437
  • Fax: 804-747-4304
Mailing address:
  • Phone: 804-475-2437
  • Fax: 804-747-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR8H17
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number29238
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: