Healthcare Provider Details

I. General information

NPI: 1265626683
Provider Name (Legal Business Name): ROBERT WINFIELD KLINK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 MEREDITH DR
GLOUCESTER VA
23061-4151
US

IV. Provider business mailing address

PO BOX 2148
GLOUCESTER VA
23061-2148
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-4410
  • Fax: 804-693-0925
Mailing address:
  • Phone: 804-693-4410
  • Fax: 804-693-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101026446
License Number StateVA

VIII. Authorized Official

Name: ROBERT W KLINK
Title or Position: OWNER
Credential: MD
Phone: 804-693-4410