Provider Demographics
NPI:1710921788
Name:DECONTI, ROBERT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:DECONTI
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 1:7229 FOREST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3765
Mailing Address - Country:US
Mailing Address - Phone:804-673-8000
Mailing Address - Fax:804-673-4067
Practice Address - Street 1:7229 FOREST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3765
Practice Address - Country:US
Practice Address - Phone:804-673-8000
Practice Address - Fax:804-673-4067
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051435208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA102128OtherPTAN GROUP
VA1326248584OtherNPI INDIVIDUAL
VAVAA102129OtherPTAN INDIVIDUAL
VA6900275Medicaid
VAF88906Medicare UPIN
VA240000201Medicare ID - Type Unspecified
VA240000202Medicare ID - Type Unspecified