Provider Demographics
NPI:1669454344
Name:ELLIOTT, ROBERT I (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
Last Name:ELLIOTT
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 1:527 POCKET RD
Mailing Address - Street 2:
Mailing Address - City:HURT
Mailing Address - State:VA
Mailing Address - Zip Code:24563-2023
Mailing Address - Country:US
Mailing Address - Phone:434-324-9150
Mailing Address - Fax:434-324-8248
Practice Address - Street 1:527 POCKET RD
Practice Address - Street 2:
Practice Address - City:HURT
Practice Address - State:VA
Practice Address - Zip Code:24563-2023
Practice Address - Country:US
Practice Address - Phone:434-324-9150
Practice Address - Fax:434-324-8248
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005618789Medicaid
VA080124260OtherMEDICARE RAILROAD
VA240963OtherANTHEM
VA005618789Medicaid
VA240963OtherANTHEM