Provider Demographics
NPI:1215089255
Name:ROBERT MANN MD WERNER MARTENS MC R MICHAEL CAMP MD & WILLIAM T NAYLOR
Entity type:Organization
Organization Name:ROBERT MANN MD WERNER MARTENS MC R MICHAEL CAMP MD & WILLIAM T NAYLOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-622-1661
Mailing Address - Street 1:902 GRAYDON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1208
Mailing Address - Country:US
Mailing Address - Phone:757-622-1661
Mailing Address - Fax:757-627-0704
Practice Address - Street 1:902 GRAYDON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1208
Practice Address - Country:US
Practice Address - Phone:757-622-1661
Practice Address - Fax:757-627-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA100062OtherOPTIMA
VA100062OtherSENTARA
VA100062OtherOPTIMA