Provider Demographics
NPI:1740386911
Name:KANE, ROBERT E III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:KANE
Suffix:III
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 1:10632 TOSTON LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6498
Mailing Address - Country:US
Mailing Address - Phone:804-475-2437
Mailing Address - Fax:804-747-4304
Practice Address - Street 1:10632 TOSTON LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6498
Practice Address - Country:US
Practice Address - Phone:804-475-2437
Practice Address - Fax:804-747-4304
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8H17208000000X
OK292382080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202531802Medicaid
MO202531802Medicaid
MO033010823Medicare ID - Type Unspecified