Provider Demographics
NPI:1437202157
Name:STAMATAKOS, MICHAEL DEANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEANE
Last Name:STAMATAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11701 MILBERN DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3525
Mailing Address - Country:US
Mailing Address - Phone:301-299-9424
Mailing Address - Fax:202-782-7166
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-4001
Practice Address - Fax:703-776-7113
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101252133207ZC0500X
MDD0037864207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology