Healthcare Provider Details

I. General information

NPI: 1578545760
Provider Name (Legal Business Name): JAMES ROBERT ROBUSTO MD,MBA,FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5399 OLD VIRGINIA STREET
URBANNA VA
23175-0880
US

IV. Provider business mailing address

860 OMNI BLVD SUITE 303
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 804-758-2110
  • Fax: 804-758-0256
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101037187
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: