Provider Demographics
NPI:1487631602
Name:MANN, JOHN WALTER III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTER
Last Name:MANN
Suffix:III
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 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-510-6200
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048448207XX0005X, 207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487631602OtherGATEWAY
VA1487631602OtherCIGNA
VA1487631602OtherUMWA
VA1487631602OtherUNITED HEALTHCARE
VA009878000OtherMEDICAID OF WEST VIRGINIA
VA371194700OtherBLACK LUNG
VAP080129534OtherRAILROAD MEDICARE
VA1487631602OtherVIRGINIA HEALTH NETWORK
VA1487631602OtherANTHEM
VA1487631602OtherHUMANA MEDICARE
VA1487631602OtherHEALTHKEEPERS
VA1487631602OtherCOVENTRY/AETNA BETTER HEALTH
VA1487631602OtherOPTIMA HEALTH PLAN
VA1487631602OtherVA PREMIER
VA1487631602OtherINTOTAL
VA1487631602OtherHEALTHKEEPERS PLUS
VA540506332115OtherTRICARE/CHAMPUS
VA1487631602OtherMAGELLAN CCP
VA1487631602OtherAETNA
VA1487631602Medicaid
VAP080129534OtherRAILROAD MEDICARE
VA1487631602OtherHEALTHKEEPERS