Provider Demographics
NPI:1568460350
Name:MCQUEEN, ROBERT CLARKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLARKSON
Last Name:MCQUEEN
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 1:1828 W PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6365
Mailing Address - Country:US
Mailing Address - Phone:540-662-9115
Mailing Address - Fax:540-665-0411
Practice Address - Street 1:1828 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-662-9115
Practice Address - Fax:540-665-0411
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032249207KA0200X
WV14655207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006082904Medicaid
WV000893525OtherMOUNTAIN STATE BC/BS
WV0070486000Medicaid
VA000893525OtherMOUNTAIN STATE BC/BS
VA032684OtherANTHEM BC/BS
WV0609442Medicare PIN
A72566Medicare UPIN
VA032684OtherANTHEM BC/BS
WV000893525OtherMOUNTAIN STATE BC/BS