Provider Demographics
NPI:1093774325
Name:ROYAL, HARRY WILLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:WILLIS
Last Name:ROYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W LEIGH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3200
Mailing Address - Country:US
Mailing Address - Phone:804-648-1601
Mailing Address - Fax:804-783-8133
Practice Address - Street 1:505 W LEIGH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3200
Practice Address - Country:US
Practice Address - Phone:804-648-1601
Practice Address - Fax:804-783-8133
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020926207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006242685Medicaid
VA006209921Medicaid
VA006209921Medicaid
VAB05069Medicare UPIN