Provider Demographics
NPI:1326248584
Name:ROBERT W. DECONTI, M.D., INC.
Entity Type:Organization
Organization Name:ROBERT W. DECONTI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DECONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-673-8000
Mailing Address - Street 1:7229 FOREST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3765
Mailing Address - Country:US
Mailing Address - Phone:804-673-8000
Mailing Address - Fax:804-673-4067
Practice Address - Street 1:7229 FOREST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3765
Practice Address - Country:US
Practice Address - Phone:804-673-8000
Practice Address - Fax:804-673-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6900275Medicaid
VAF88906Medicare UPIN