Healthcare Provider Details

I. General information

NPI: 1528010097
Provider Name (Legal Business Name): ROBERT E. MAYFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 WATERCOVE RD
MIDLOTHIAN VA
23112-3982
US

IV. Provider business mailing address

13332 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-4210
US

V. Phone/Fax

Practice location:
  • Phone: 804-744-0200
  • Fax: 804-744-8417
Mailing address:
  • Phone: 804-794-5598
  • Fax: 804-858-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101058018
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: