Provider Demographics
NPI:1528010097
Name:MAYFIELD, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13332 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4210
Mailing Address - Country:US
Mailing Address - Phone:804-794-5598
Mailing Address - Fax:804-858-0181
Practice Address - Street 1:3000 WATERCOVE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3982
Practice Address - Country:US
Practice Address - Phone:804-744-0200
Practice Address - Fax:804-744-8417
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540883363OtherPHCS
VA540883363OtherPREFERRED CARE
VA540883363OtherVIRGINIA HEALTH NETWORK
VA11294OtherCIGNA
VA0101883OtherUNITED HEALTHCARE
VA540883363OtherCHAMPUS-TRICARE
VA216367OtherANTHEM
VA36466OtherOPTIMA
VA540883363OtherGREAT WEST HEALTHCARE
VA881711OtherMAMSI
VA125421OtherSOUTHERN HEALTH
VA540189OtherAETNA
VA540883363OtherFIRST HEALT/CCN
VA5610401Medicaid
VA080158400Medicare PIN
VA540883363OtherPHCS
VA36466OtherOPTIMA
VAB89798Medicare UPIN
VA080007348Medicare PIN