Healthcare Provider Details

I. General information

NPI: 1255394417
Provider Name (Legal Business Name): SHARON A GOBLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DR SUITE 100
RICHMOND VA
23235-4730
US

IV. Provider business mailing address

7202 GLEN FOREST DR SUITE 200
RICHMOND VA
23226-3781
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-7990
  • Fax: 804-330-2701
Mailing address:
  • Phone: 804-673-0134
  • Fax: 804-673-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101057936
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: