Healthcare Provider Details

I. General information

NPI: 1467633974
Provider Name (Legal Business Name): ROBERT J. NORGROVE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9166 N CONGRESS ST
NEW MARKET VA
22844-9422
US

IV. Provider business mailing address

11110 MEDICAL CAMPUS RD STE 205
HAGERSTOWN MD
21742-6797
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-1380
  • Fax: 540-459-1349
Mailing address:
  • Phone: 301-665-4950
  • Fax: 301-665-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053190
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004565
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: