Provider Demographics
NPI:1316971609
Name:BETTINI, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BETTINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:J
Other - Last Name:BETTINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9004 CROWNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1630
Mailing Address - Country:US
Mailing Address - Phone:703-978-5440
Mailing Address - Fax:703-978-0764
Practice Address - Street 1:9004 CROWNWOOD CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1630
Practice Address - Country:US
Practice Address - Phone:703-978-5440
Practice Address - Fax:703-978-0764
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019403207V00000X
VA0745587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA111206B09Medicare PIN
VAB93435Medicare UPIN