Basic Information
| Provider Information | |||||||||
| NPI: | 1225090509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAMPITT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | VAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 TERRACE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767837167 | ||||||||
| FaxNumber: | 2767836432 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 TERRACE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767837167 | ||||||||
| FaxNumber: | 2767836432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101044814 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080120201 | 01 | VA | RAILROAD MEDICARE | OTHER | 1620892 | 01 | VA | COVENTRY HEALTH | OTHER | 240909 | 01 | VA | ANTHEM BCBS | OTHER | 005619068 | 05 | VA | MEDICAID |