Provider Demographics
NPI:1518944842
Name:FERN, ROBERT J (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:FERN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9505
Mailing Address - Country:US
Mailing Address - Phone:540-949-0118
Mailing Address - Fax:540-949-8903
Practice Address - Street 1:108 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9505
Practice Address - Country:US
Practice Address - Phone:540-949-0118
Practice Address - Fax:540-949-8903
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231252208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006718868Medicaid
10008691OtherOPTIMA
1953974OtherFIRST HEALTH
426927OtherSOUTHERN HEALTH
199585OtherANTHEM
0169026OtherCIGNA