Provider Demographics
NPI:1831163682
Name:OBERMEYER, PHAIK MAE (MD)
Entity type:Individual
Prefix:
First Name:PHAIK
Middle Name:MAE
Last Name:OBERMEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:400 W BRAMBLETON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1115
Practice Address - Country:US
Practice Address - Phone:757-627-6220
Practice Address - Fax:757-627-0200
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherMID ATLANTIC SOLUTIONS
VA10002704OtherSENTARA/OPTIMA
VA010203198Medicaid
008971B28Medicare PIN
VA010203198Medicaid