Provider Demographics
NPI:1922054741
Name:VANCE, ROBERT ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:VANCE
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 1:669 PARISHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GORE
Mailing Address - State:VA
Mailing Address - Zip Code:22637-2239
Mailing Address - Country:US
Mailing Address - Phone:774-759-1940
Mailing Address - Fax:
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-7780
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15160207L00000X
CODR.0059004207L00000X
PAMD423044207L00000X
VA0101269074207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE82859Medicare UPIN
WV4258601Medicare PIN
WV0041132000Medicaid
WV9333201OtherGROUP MEDICARE
PA0012304440001Medicaid
WV4258601Medicare PIN