Provider Demographics
NPI:1497729180
Name:FEINBERG, ROBERT A (PAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:FEINBERG
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3002
Mailing Address - Country:US
Mailing Address - Phone:757-395-2323
Mailing Address - Fax:757-395-6280
Practice Address - Street 1:1060 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-395-2323
Practice Address - Fax:757-395-6280
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002319L363A00000X
VA0110004952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S47448Medicare UPIN
PA004598Medicare ID - Type Unspecified