Provider Demographics
NPI:1124587324
Name:HARGROVE, RICHARD STEWART ROBERTSON
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEWART ROBERTSON
Last Name:HARGROVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16637 MLC LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23146-1855
Mailing Address - Country:US
Mailing Address - Phone:804-514-2257
Mailing Address - Fax:
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:540-776-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine