Provider Demographics
NPI:1376553982
Name:SEFCZEK, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SEFCZEK
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 1:200 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1000
Mailing Address - Country:US
Mailing Address - Phone:540-743-9439
Mailing Address - Fax:540-743-1391
Practice Address - Street 1:200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1000
Practice Address - Country:US
Practice Address - Phone:540-743-9439
Practice Address - Fax:540-743-1391
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME913012085R0202X
VA01012418842085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376553982Medicaid
FL270560500Medicaid
B42244Medicare UPIN
VA1376553982Medicaid
FL49012BMedicare PIN