Provider Demographics
NPI:1336144807
Name:MICHIE, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:MICHIE
Suffix:
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 1:306 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:23944-2050
Mailing Address - Country:US
Mailing Address - Phone:434-676-8021
Mailing Address - Fax:434-676-2390
Practice Address - Street 1:306 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944-2050
Practice Address - Country:US
Practice Address - Phone:434-676-8021
Practice Address - Fax:434-676-2390
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080182337OtherSH RAILROAD MEDICARE
VA30021OtherOPTIMA KB
VA005600839Medicaid
VA005600880OtherVA PREMIER KB
VA010252474Medicaid
VA1336144807OtherNPI
VA1336144807Medicaid
VA189202OtherBCBS #
VA21524OtherCARENET
VA451951OtherBCBS #
VAA1909OtherMEDCOST
VA33774OtherOPTIMA SH
VA5903140OtherNC MEDICAID
VA7425224OtherAETNA
VA99600OtherMEDCOST KB
VA005600839OtherVA PREMIER
VA5038791OtherCIGNA
VA080164906OtherKB RAILROAD MEDICARE
VA22116OtherCARENET KB
VA290297OtherSOUTHERN HEALTH
VA290696OtherSOUTHERN HEALTH KB
VA005600880Medicaid
VA451950OtherBCBS #
VA493833Medicare Oscar/Certification
VA005600839OtherVA PREMIER
VA5903140OtherNC MEDICAID
VA080164906OtherKB RAILROAD MEDICARE
VA1336144807OtherNPI
VA005600880Medicaid
VA21524OtherCARENET
VA290297OtherSOUTHERN HEALTH
VA290297OtherSOUTHERN HEALTH