Provider Demographics
NPI:1992036768
Name:SCOTT, ROBERT III
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SCOTT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 BROOK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1817
Mailing Address - Country:US
Mailing Address - Phone:804-591-8633
Mailing Address - Fax:804-261-2226
Practice Address - Street 1:7400 BROOK RD
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1817
Practice Address - Country:US
Practice Address - Phone:804-591-8633
Practice Address - Fax:804-261-2226
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1335-05-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health