Provider Demographics
NPI:1356496988
Name:HATTWICK, MICHAEL ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALBERT
Last Name:HATTWICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8301 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2902
Mailing Address - Country:US
Mailing Address - Phone:703-698-9000
Mailing Address - Fax:703-876-8911
Practice Address - Street 1:8301 ARLINGTON BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-698-9000
Practice Address - Fax:703-876-8911
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101028343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB93669Medicare UPIN