Provider Demographics
NPI:1861600389
Name:MAURER, CHRISTOPHER ROBIN (IDC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBIN
Last Name:MAURER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 LAKE HAVASU DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3976
Mailing Address - Country:US
Mailing Address - Phone:757-340-4357
Mailing Address - Fax:
Practice Address - Street 1:NCWS 4, IBU 41
Practice Address - Street 2:NNSY BLDG 11
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23709
Practice Address - Country:US
Practice Address - Phone:757-967-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman