Provider Demographics
NPI:1063104537
Name:MATTHEWS, ROBYN RENEE
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:RENEE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 BRANCH AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2630
Mailing Address - Country:US
Mailing Address - Phone:571-268-2164
Mailing Address - Fax:
Practice Address - Street 1:6487 OLD BEULAH ST STE 4
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3723
Practice Address - Country:US
Practice Address - Phone:302-293-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1201131262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist