MEDICARE: DR. ROBERT CLARKSON MCQUEEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician	0101032249	VA
2	207KA0200X	Allergy Physician	14655	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000893525	OTHER	WV	MOUNTAIN STATE BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000893525	OTHER	VA	MOUNTAIN STATE BC/BS
5	032684	OTHER	VA	ANTHEM BC/BS

General Provider Information

NPI Number	:	1568460350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CLARKSON MCQUEEN M.D.

Provider Business Mailing Address
First Line	:	1828 W PLAZA DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6365
Country	:	US
Telephone Number	:	540-662-9115
Fax Number	:	540-665-0411

Provider Business Practice Location Address
First Line	:	1828 W PLAZA DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6365
Country	:	US
Telephone Number	:	540-662-9115
Fax Number	:	540-665-0411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	12/02/2013

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