Provider Demographics
NPI:1366524183
Name:MORTON, ROBERT EDMUND
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDMUND
Last Name:MORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10108 S GLEN RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4132
Mailing Address - Country:US
Mailing Address - Phone:703-217-1621
Mailing Address - Fax:301-299-1712
Practice Address - Street 1:1715 N GEORGE MASON DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3609
Practice Address - Country:US
Practice Address - Phone:703-522-7476
Practice Address - Fax:703-528-4209
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025911207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
044551R69Medicare PIN
C61619Medicare UPIN