Provider Demographics
NPI:1306826607
Name:BALCOM, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BALCOM
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 1:816 QUAIL POINT CV
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3156
Mailing Address - Country:US
Mailing Address - Phone:757-412-0054
Mailing Address - Fax:
Practice Address - Street 1:2810 N PARHAM RD
Practice Address - Street 2:SUITE 250
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4434
Practice Address - Country:US
Practice Address - Phone:888-627-4702
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010455032080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F26810Medicare UPIN