Provider Demographics
NPI:1396755948
Name:LAIBSTAIN, ROBERT BERNARD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BERNARD
Last Name:LAIBSTAIN
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 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:1016 JUSTIS ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325
Practice Address - Country:US
Practice Address - Phone:757-420-8297
Practice Address - Fax:757-523-5639
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11017OtherSENTARA
028829OtherANTHEM
VA5664250Medicaid
VA080000763Medicare PIN
080000763Medicare ID - Type Unspecified
B06563Medicare UPIN