Healthcare Provider Details

I. General information

NPI: 1487748448
Provider Name (Legal Business Name): ROBERT BERROTERRAN ESCALERA II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

601 CHILDREN'S LANE DIVISION OF PEDIATRIC CARDIOLOGY
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7214
  • Fax: 757-668-8225
Mailing address:
  • Phone: 757-668-7214
  • Fax: 757-668-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101241663
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: