Provider Demographics
NPI:1639143217
Name:FLEMMER, MARK CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTIAN
Last Name:FLEMMER
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-889-5432
Mailing Address - Fax:757-889-5930
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-889-5432
Practice Address - Fax:757-889-5930
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049048207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherCIGNA
VAPAROtherCORVEL/CORECARE
VA41061OtherSENTARA OPTIMA
VA12868OtherSENTARA OPTIMA
VA327458OtherUHC/MAMSI
VA-028OtherTRICARE/CHAMPUS
NC0644KOtherBC/BC
VA227458OtherUHC/MAMSI
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH
VA005806003Medicaid
VA006074251Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
VA058217OtherANTHEM
NC890664KMedicaid
VAPAROtherMULTIPLAN
VA332775OtherANTHEM
VAPAROtherUSA MANAGED CARE
VAPAROtherAETNA
VA110074244Medicare PIN
VA058217OtherANTHEM
VA41061OtherSENTARA OPTIMA
VA327458OtherUHC/MAMSI