Healthcare Provider Details

I. General information

NPI: 1114306982
Provider Name (Legal Business Name): MATTHEW ROBICHAUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014
US

IV. Provider business mailing address

1501 BRANDON AVE SW
ROANOKE VA
24015-2930
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7000
  • Fax:
Mailing address:
  • Phone: 802-558-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101262543
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: