Provider Demographics
NPI:1316157761
Name:PASSMAN, COREY (MD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:PASSMAN
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 1:1204 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2112
Mailing Address - Country:US
Mailing Address - Phone:434-200-3656
Mailing Address - Fax:
Practice Address - Street 1:2542 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1602
Practice Address - Country:US
Practice Address - Phone:434-200-5297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243684208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
203639329030OtherTRICARE
203639329027OtherTRICARE
203639329029OtherTRICARE
362160OtherANTHEM
358897OtherANTHEM
359504OtherANTHEM
359504OtherANTHEM