Provider Demographics
NPI:1922068154
Name:HARVEY, ROBERT L JR (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HARVEY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 N PIFER RD
Mailing Address - Street 2:
Mailing Address - City:STAR TANNERY
Mailing Address - State:VA
Mailing Address - Zip Code:22654-1921
Mailing Address - Country:US
Mailing Address - Phone:540-465-1965
Mailing Address - Fax:
Practice Address - Street 1:20251 CENTURY BLVD
Practice Address - Street 2:STE 130
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1162
Practice Address - Country:US
Practice Address - Phone:301-944-0033
Practice Address - Fax:240-485-0917
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201169207P00000X
MDH0069397207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064007Medicaid
VA1922068154OtherNPI
VA147025OtherANTHEM
VA540490687003OtherTRICARE
MD418573100Medicaid
VA004098S48Medicare ID - Type Unspecified
MD418573100Medicaid
MDP00771351Medicare PIN
VA010064007Medicaid