MEDICARE: JOAN ELIZABETH ROUNTREE MD

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	207N00000X	Dermatology Physician	0101047640	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070005399	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	077290	OTHER	ANTHEM
2	533019	OTHER	AETNA
4	0300083	OTHER	UNITED HEALTHCARE
5	60208	OTHER	SOUTHERN HEALTH
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659371284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN ELIZABETH ROUNTREE MD

Provider Business Mailing Address
First Line	:	301 CONCOURSE BLVD
Second Line	:	SUITE 190
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059
Country	:	US
Telephone Number	:	804-549-4030
Fax Number	:	804-549-4032

Provider Business Practice Location Address
First Line	:	5421 PATTERSON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2003
Country	:	US
Telephone Number	:	804-285-2006
Fax Number	:	804-285-2799

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	06/08/2015

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Directions to “ JOAN ELIZABETH ROUNTREE MD” Practice Location

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