Provider Demographics
NPI:1225568587
Name:DAVID, MICHAEL KEVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:DAVID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2696 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8106
Mailing Address - Country:US
Mailing Address - Phone:276-638-7205
Mailing Address - Fax:276-638-3389
Practice Address - Street 1:2696 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-8106
Practice Address - Country:US
Practice Address - Phone:276-638-7205
Practice Address - Fax:276-638-3389
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116030465207Q00000X
VA0102205571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine