Provider Demographics
NPI:1487631602
Name:MANN, JOHN WALTER III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTER
Last Name:MANN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-510-6200
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048448207XX0005X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009878000OtherMEDICAID OF WEST VIRGINIA
VA1487631602OtherANTHEM
VA1487631602OtherAETNA
VA371194700OtherBLACK LUNG
VAP080129534OtherRAILROAD MEDICARE
VA1487631602OtherUMWA
VA1487631602OtherMAGELLAN CCP
VA1487631602OtherHUMANA MEDICARE
VA1487631602Medicaid
VA1487631602OtherGATEWAY
VA1487631602OtherCIGNA
VA1487631602OtherOPTIMA HEALTH PLAN
VA1487631602OtherHEALTHKEEPERS
VA540506332115OtherTRICARE/CHAMPUS
VA1487631602OtherHEALTHKEEPERS PLUS
VA1487631602OtherUNITED HEALTHCARE
VA1487631602OtherCOVENTRY/AETNA BETTER HEALTH
VA1487631602OtherVA PREMIER
VA1487631602OtherVIRGINIA HEALTH NETWORK
VA1487631602OtherINTOTAL
VAP080129534OtherRAILROAD MEDICARE
VA1487631602OtherHEALTHKEEPERS