Provider Demographics
NPI:1447205158
Name:ABBOT, DAVID MUNRO (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MUNRO
Last Name:ABBOT
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 1:9001 WINDING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2106
Mailing Address - Country:US
Mailing Address - Phone:703-938-7145
Mailing Address - Fax:
Practice Address - Street 1:9001 WINDING CREEK LN
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2106
Practice Address - Country:US
Practice Address - Phone:703-938-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
540955819OtherTAX ID
VA024252OtherANTHEM
VA069624Medicare PIN
540955819OtherTAX ID