Provider Demographics
NPI:1700808359
Name:WILLIAMSBURG ENDOCRINOLOGY INC
Entity Type:Organization
Organization Name:WILLIAMSBURG ENDOCRINOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-565-9586
Mailing Address - Street 1:207 BULIFANTS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5732
Mailing Address - Country:US
Mailing Address - Phone:757-565-9586
Mailing Address - Fax:757-565-9588
Practice Address - Street 1:207 BULIFANTS BLVD STE D
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5732
Practice Address - Country:US
Practice Address - Phone:757-565-9586
Practice Address - Fax:757-565-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059029207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5882648Medicaid
VA5882648Medicaid
VA00V293W63Medicare ID - Type Unspecified