Provider Demographics
NPI:1235170655
Name:TABER, ROBERT LORIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LORIN
Last Name:TABER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6477 COLLEGE PARK SQ STE 316
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3611
Mailing Address - Country:US
Mailing Address - Phone:800-637-3627
Mailing Address - Fax:757-420-6616
Practice Address - Street 1:315 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1254
Practice Address - Country:US
Practice Address - Phone:509-488-2636
Practice Address - Fax:509-331-2617
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00030769207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8158131Medicaid
WAE70238Medicare UPIN