Provider Demographics
NPI:1659371284
Name:ROUNTREE, JOAN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ELIZABETH
Last Name:ROUNTREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:ROUNTREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:301 CONCOURSE BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-549-4030
Mailing Address - Fax:804-549-4032
Practice Address - Street 1:5421 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2003
Practice Address - Country:US
Practice Address - Phone:804-285-2006
Practice Address - Fax:804-285-2799
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047640207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
077290OtherANTHEM
533019OtherAETNA
070005399OtherRAILROAD MEDICARE
0300083OtherUNITED HEALTHCARE
60208OtherSOUTHERN HEALTH
VA5940494Medicaid
F56112Medicare UPIN
070005399OtherRAILROAD MEDICARE