Provider Demographics
NPI:1023083417
Name:ANDERSON, ROBIN NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:NICOLE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2017 PLEASURE HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2709
Mailing Address - Country:US
Mailing Address - Phone:757-318-6900
Mailing Address - Fax:757-318-6901
Practice Address - Street 1:2017 PLEASURE HOUSE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2709
Practice Address - Country:US
Practice Address - Phone:757-318-6900
Practice Address - Fax:757-318-6901
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010174511Medicaid
007845S33Medicare ID - Type Unspecified
VA010174511Medicaid