Provider Demographics
NPI:1184680795
Name:OLDER, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:OLDER
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 1:9105 STONY POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9105 STONY POINT PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1979
Practice Address - Country:US
Practice Address - Phone:804-287-1030
Practice Address - Fax:804-288-3529
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 0201362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA64186OtherSENTARA FAMILY CARE
VA8036132OtherCIGNA
VA2137661OtherALLIANCE
VA299905OtherSOUTHERN HEALTH
VA53223OtherCARENET
VACA4541OtherRAILROAD MEDICARE GROUP #
VAC06623OtherMEDICARE GROUP #
VAP00175475OtherRAILROAD MEDICARE
VA1053721OtherAETNA HMO
VA1603383OtherUNITED HEALTHCARE
VA5475270OtherAETNA PPO
VAC82407Medicare UPIN
VAP00175475OtherRAILROAD MEDICARE