Provider Demographics
NPI:1265626683
Name:ROBERT WINFIELD KLINK
Entity type:Organization
Organization Name:ROBERT WINFIELD KLINK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-693-4410
Mailing Address - Street 1:PO BOX 2148
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-2148
Mailing Address - Country:US
Mailing Address - Phone:804-693-4410
Mailing Address - Fax:804-693-0925
Practice Address - Street 1:7685 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4151
Practice Address - Country:US
Practice Address - Phone:804-693-4410
Practice Address - Fax:804-693-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026446207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006288073Medicaid
VAB06627Medicare UPIN
VA006288073Medicaid