Healthcare Provider Details

I. General information

NPI: 1710921788
Provider Name (Legal Business Name): ROBERT WILLIAM DECONTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7229 FOREST AVE SUITE 101
RICHMOND VA
23226-3765
US

IV. Provider business mailing address

7229 FOREST AVE SUITE 101
RICHMOND VA
23226-3765
US

V. Phone/Fax

Practice location:
  • Phone: 804-673-8000
  • Fax: 804-673-4067
Mailing address:
  • Phone: 804-673-8000
  • Fax: 804-673-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101051435
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0101051435
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: