Provider Demographics
NPI:1598733131
Name:ROBILLARD, ROBERT BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:ROBILLARD
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:PO BOX 10030
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5001
Mailing Address - Country:US
Mailing Address - Phone:434-799-9999
Mailing Address - Fax:434-799-1301
Practice Address - Street 1:159 EXECUTIVE DR
Practice Address - Street 2:SUITE J
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-799-9999
Practice Address - Fax:434-799-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046865207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006501044Medicaid
VA040000505Medicare PIN
VA006501044Medicaid