Healthcare Provider Details

I. General information

NPI: 1982812681
Provider Name (Legal Business Name): ROBERT FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4500
US

IV. Provider business mailing address

107 WADSWORTH DR
RICHMOND VA
23236-4521
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-4201
  • Fax: 804-272-6895
Mailing address:
  • Phone: 804-330-4901
  • Fax: 804-330-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101242145
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: