Provider Demographics
NPI:1164080321
Name:NOTTINGHAM, ROBERT REID JR (CSA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:REID
Last Name:NOTTINGHAM
Suffix:JR
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WILSON BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5435
Mailing Address - Country:US
Mailing Address - Phone:757-439-0033
Mailing Address - Fax:
Practice Address - Street 1:2300 WILSON BLVD STE 700
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5435
Practice Address - Country:US
Practice Address - Phone:757-439-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5016246ZC0007X
VA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant