Provider Demographics
NPI:1619053659
Name:HIGGINSON, ROBERT T JR (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:HIGGINSON
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0510
Practice Address - Country:US
Practice Address - Phone:804-628-0153
Practice Address - Fax:804-828-2338
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110840343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010107130 541581185Medicaid
VAQ30159Medicare UPIN
VA005941M84 C03684Medicare ID - Type Unspecified