Provider Demographics
NPI:1104832542
Name:OBERMEYER, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:OBERMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741593
Mailing Address - Street 2:CHILDRENS SURGICAL SPECIALTY GROUP INC
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1593
Mailing Address - Country:US
Mailing Address - Phone:757-668-7703
Mailing Address - Fax:757-668-8860
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7703
Practice Address - Fax:757-668-8860
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012376562086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2137379OtherMAMSI/OPTIMUM CHOICE
VA3116108340000EOtherCIGNA
NC5900564Medicaid
VA5900564OtherNORTH CAROLINA MEDICAID
VA2137379OtherALLIANCE/MDIPA
VA179040OtherANTHEM BCBS
VA010151660Medicaid
VA95794OtherOPTIMA/SENTARA HEALTH
VA95794OtherOPTIMA/SENTARA HEALTH
VAC06141Medicare PIN