Provider Demographics
NPI:1356050306
Name:CAULDER, ROBERT BOYD BEAU (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BOYD BEAU
Last Name:CAULDER
Suffix:
Gender:M
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 VAN BUREN DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3140
Mailing Address - Country:US
Mailing Address - Phone:757-802-1891
Mailing Address - Fax:
Practice Address - Street 1:3645 VAN BUREN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3140
Practice Address - Country:US
Practice Address - Phone:757-802-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185627208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice