Provider Demographics
NPI:1013013309
Name:DICKMAN, MICHAEL MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:DICKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:EXECUTIVE MEDICINE
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060
Mailing Address - Country:US
Mailing Address - Phone:571-231-0540
Mailing Address - Fax:571-231-6697
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:EXECUTIVE MEDICINE
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:712-310-5405
Practice Address - Fax:571-231-6697
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider