Provider Demographics
NPI:1982611141
Name:KETCHAM, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:KETCHAM
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 1:6614 HEIDI CT
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-1606
Mailing Address - Country:US
Mailing Address - Phone:703-356-3327
Mailing Address - Fax:703-356-7336
Practice Address - Street 1:5225 CONNECTICUT AVE. NW
Practice Address - Street 2:#404
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:22101-1813
Practice Address - Country:US
Practice Address - Phone:202-244-5501
Practice Address - Fax:703-356-7336
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD73122084P0800X
VA01010293082084P0800X
MDD00192622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry