Healthcare Provider Details

I. General information

NPI: 1376553982
Provider Name (Legal Business Name): ROBERT J. SEFCZEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL DR
LURAY VA
22835-1000
US

IV. Provider business mailing address

200 MEMORIAL DR
LURAY VA
22835-1000
US

V. Phone/Fax

Practice location:
  • Phone: 540-743-9439
  • Fax: 540-743-1391
Mailing address:
  • Phone: 540-743-9439
  • Fax: 540-743-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME91301
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number0101241884
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: