Healthcare Provider Details

I. General information

NPI: 1700808359
Provider Name (Legal Business Name): WILLIAMSBURG ENDOCRINOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BULIFANTS BLVD STE D
WILLIAMSBURG VA
23188-5732
US

IV. Provider business mailing address

207 BULIFANTS BLVD STE D
WILLIAMSBURG VA
23188-5732
US

V. Phone/Fax

Practice location:
  • Phone: 757-565-9586
  • Fax: 757-565-9588
Mailing address:
  • Phone: 757-565-9586
  • Fax: 757-565-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101059029
License Number StateVA

VIII. Authorized Official

Name: DR. KATHERINE A ROBERTS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-565-9586