Provider Demographics
NPI:1730104001
Name:HENLEY, ROBERT W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:HENLEY
Suffix:JR
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 1:681 HIOAKS RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4043
Mailing Address - Country:US
Mailing Address - Phone:804-323-1804
Mailing Address - Fax:804-330-0252
Practice Address - Street 1:681 HIOAKS RD
Practice Address - Street 2:SUITE H
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4043
Practice Address - Country:US
Practice Address - Phone:804-323-1804
Practice Address - Fax:804-330-0252
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA530900OtherAETNA
VA060020409OtherRAILROAD MEDICARE
VA1471141OtherCIGNA
VA006022543Medicaid
VA410609OtherUNITED HEALTHCARE
VA006022543Medicaid
VAC47362Medicare UPIN