Provider Demographics
NPI:1235107525
Name:LOCKRIDGE, ROBERT S JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:LOCKRIDGE
Suffix:JR
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 1:103 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1460
Mailing Address - Country:US
Mailing Address - Phone:434-947-3954
Mailing Address - Fax:434-947-5944
Practice Address - Street 1:103 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1460
Practice Address - Country:US
Practice Address - Phone:434-947-3954
Practice Address - Fax:434-947-5944
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5854571Medicaid
VA08970Medicare UPIN
VA390000162Medicare ID - Type Unspecified