Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0101032249 | VA |
N | 207KA0200X | Allergist | 14655 | WV |
NPI | 1568460350 |
---|---|
Provider Name | Dr. Robert Clarkson Mcqueen |
First Address | Winchester, VA 22601-6365 |
Second Address | Winchester, VA 22601-6365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 02/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000893525 | MOUNTAIN STATE BC/BS (01) | VA |
000893525 | MOUNTAIN STATE BC/BS (01) | WV |
006082904 | (05) | VA |
0070486000 | (05) | WV |
032684 | ANTHEM BC/BS (01) | VA |
A72566 | (02) |