Healthcare Provider Details

I. General information

NPI: 1912125147
Provider Name (Legal Business Name): ROBERT LEWIS KOFFMAN MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL NAVAL MEDICAL CTR 8901 ROCKVILLE PIKE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

PO BOX 5979
VIRGINIA BEACH VA
23471-0979
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4611
  • Fax:
Mailing address:
  • Phone: 571-215-0576
  • Fax: 202-762-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: