Provider Demographics
NPI:1760910202
Name:ABBOTT, ROBERT DUDLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DUDLEY
Last Name:ABBOTT
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 1:355 RIO RD W STE 206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1361
Mailing Address - Country:US
Mailing Address - Phone:434-218-3425
Mailing Address - Fax:434-215-0727
Practice Address - Street 1:355 RIO RD W STE 206
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1361
Practice Address - Country:US
Practice Address - Phone:434-218-3425
Practice Address - Fax:434-215-0727
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101265422207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine