Provider Demographics
NPI:1750310082
Name:SQUIRE, ROBERT HALL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HALL
Last Name:SQUIRE
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 1:219 WEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1248
Mailing Address - Country:US
Mailing Address - Phone:434-634-4148
Mailing Address - Fax:
Practice Address - Street 1:219 WEAVER AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1248
Practice Address - Country:US
Practice Address - Phone:434-634-4148
Practice Address - Fax:434-634-6963
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045828207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE65992Medicare UPIN