Provider Demographics
NPI:1174687917
Name:ACKERMAN, MICHAEL KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEITH
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WEST SHIRLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-9220
Mailing Address - Fax:540-347-0492
Practice Address - Street 1:555 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3028
Practice Address - Country:US
Practice Address - Phone:540-347-5512
Practice Address - Fax:540-341-4646
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA885926OtherMAMSI PROVIDER NUMBER
VA8195981OtherCIGNA PROVIDER NUMBER
VA2473397OtherAETNA PROVIDER NUMBER
VA5846838Medicaid
VA274674OtherANTHEM PROVIDER NUMBER
VA060860000OtherSOUTHERN HEALTH PROVIDER
DC50820004OtherCAREFIRST PROVIDER NUMBER
DC50820004OtherCAREFIRST PROVIDER NUMBER
VAH19841Medicare UPIN
VA885926OtherMAMSI PROVIDER NUMBER