Healthcare Provider Details

I. General information

NPI: 1659368538
Provider Name (Legal Business Name): ROBERT MAMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WASHINGTON BLVD
ARLINGTON VA
22204-5703
US

IV. Provider business mailing address

12301 SAINT JAMES RD
POTOMAC MD
20854-2168
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5150
  • Fax: 703-228-5157
Mailing address:
  • Phone: 240-535-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101037172
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0032839
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: