Provider Demographics
NPI:1841246600
Name:DANDRIDGE, WILLIAM ROBERT JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:DANDRIDGE
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:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-977-9808
Practice Address - Street 1:315 10TH ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902
Practice Address - Country:US
Practice Address - Phone:434-654-1950
Practice Address - Fax:434-977-9808
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B09628Medicare UPIN
VAVVH369AMedicare PIN
VAP01509121Medicare PIN
VA115894OtherSOUTHERN HEALTH
VA081930376Medicare PIN
VA867060OtherMAMSI
VA001126Medicaid
VA43427Medicaid
VAP00425684OtherMEDICARE PIN
B09628Medicare UPIN