Healthcare Provider Details

I. General information

NPI: 1316157761
Provider Name (Legal Business Name): COREY PASSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 LANGHORNE RD
LYNCHBURG VA
24501-1602
US

IV. Provider business mailing address

1204 FENWICK DR
LYNCHBURG VA
24502-2112
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5297
  • Fax:
Mailing address:
  • Phone: 434-200-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101243684
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: