Provider Demographics
NPI:1912125147
Name:KOFFMAN, ROBERT LEWIS (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:KOFFMAN
Suffix:
Gender:M
Credentials:MD, MPH
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 5979
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-0979
Mailing Address - Country:US
Mailing Address - Phone:571-215-0576
Mailing Address - Fax:202-762-3023
Practice Address - Street 1:NATIONAL NAVAL MEDICAL CTR
Practice Address - Street 2:8901 ROCKVILLE PIKE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-295-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)