Provider Demographics
NPI:1619157013
Name:JAMES R. ROBUSTO
Entity Type:Organization
Organization Name:JAMES R. ROBUSTO
Other - Org Name:URBANNA FAMILY PRACTICE,PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-758-2110
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:URBANNA
Mailing Address - State:VA
Mailing Address - Zip Code:23175-0880
Mailing Address - Country:US
Mailing Address - Phone:804-758-2110
Mailing Address - Fax:804-758-0256
Practice Address - Street 1:5399 OLD VIRGINIA ST.
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080009697OtherMEDICARE RAILROAD
VAC06252OtherMEDICARE PTAN
VA5670411Medicaid
080001119Medicare PIN
VAC06252OtherMEDICARE PTAN