MEDICARE: DR. ROBERT A HEAD 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	208000000X	Pediatrics Physician	0101261466	VA

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

General Provider Information

NPI Number	:	1659378420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A HEAD MD

Provider Business Mailing Address
First Line	:	321 RYEFIELD RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-7226
Country	:	US
Telephone Number	:	804-784-5195
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 RYEFIELD RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-7226
Country	:	US
Telephone Number	:	804-784-5195
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/09/2019

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