Provider Demographics
NPI:1578545760
Name:ROBUSTO, JAMES ROBERT (MD,MBA,FAAFP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:ROBUSTO
Suffix:
Gender:M
Credentials:MD,MBA,FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:5399 OLD VIRGINIA STREET
Practice Address - Street 2:
Practice Address - City:URBANNA
Practice Address - State:VA
Practice Address - Zip Code:23175-0880
Practice Address - Country:US
Practice Address - Phone:804-758-2110
Practice Address - Fax:804-758-0256
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5670411Medicaid
VAC06252OtherPTAN
VAC06252OtherPTAN
VA080001119Medicare PIN