Healthcare Provider Details

I. General information

NPI: 1861600389
Provider Name (Legal Business Name): CHRISTOPHER ROBIN MAURER IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NCWS 4, IBU 41 NNSY BLDG 11
PORTSMOUTH VA
23709
US

IV. Provider business mailing address

413 LAKE HAVASU DR
VIRGINIA BEACH VA
23454-3976
US

V. Phone/Fax

Practice location:
  • Phone: 757-967-4508
  • Fax:
Mailing address:
  • Phone: 757-340-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: