Provider Demographics
NPI:1609867555
Name:HALLMANN, CLEMENS ERWIN (MD)
Entity Type:Individual
Prefix:
First Name:CLEMENS
Middle Name:ERWIN
Last Name:HALLMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13911 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114
Mailing Address - Country:US
Mailing Address - Phone:804-320-3999
Mailing Address - Fax:804-323-9383
Practice Address - Street 1:13911 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114
Practice Address - Country:US
Practice Address - Phone:804-320-3999
Practice Address - Fax:804-323-9383
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101027750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5673780Medicaid
VA011654OtherANTHEM BC
B60162Medicare UPIN