Provider Demographics
NPI:1497119234
Name:RETTENMAIER, CHRISTOPHER R (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:RETTENMAIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:RAPHAEL
Other - Last Name:RETTENMAIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6251 E VIRGINIA BEACH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2824
Mailing Address - Country:US
Mailing Address - Phone:757-261-5000
Mailing Address - Fax:
Practice Address - Street 1:6251 E VIRGINIA BEACH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2824
Practice Address - Country:US
Practice Address - Phone:757-261-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101273042208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program