Provider Demographics
NPI:1164473146
Name:DAVIS, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 OLD WAGNER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9313
Mailing Address - Country:US
Mailing Address - Phone:804-524-2260
Mailing Address - Fax:804-524-0096
Practice Address - Street 1:601 OLD WAGNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9313
Practice Address - Country:US
Practice Address - Phone:804-524-2260
Practice Address - Fax:804-524-0096
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2016-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101035420207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
110132404OtherRAILROAD MEDICARE
VA6089127Medicaid
VA060000689Medicare PIN
VA6089127Medicaid