Provider Demographics
NPI:1073799839
Name:THE PHYSICIAN AND MIDWIFE COLLABORATIVE PRACTICE
Entity Type:Organization
Organization Name:THE PHYSICIAN AND MIDWIFE COLLABORATIVE PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAMMITTORIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-370-4300
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 902
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1313
Mailing Address - Country:US
Mailing Address - Phone:703-370-4300
Mailing Address - Fax:
Practice Address - Street 1:5901 KINGSTOWNE VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5880
Practice Address - Country:US
Practice Address - Phone:703-922-3434
Practice Address - Fax:703-922-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00252OtherMEDICARE