Provider Demographics
NPI:1659560324
Name:MICHEAL C PISTOLE, MD
Entity Type:Organization
Organization Name:MICHEAL C PISTOLE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PISTOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-331-1042
Mailing Address - Street 1:2112 F ST NW
Mailing Address - Street 2:SUITE 603
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2112 F ST NW
Practice Address - Street 2:SUITE 603
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2715
Practice Address - Country:US
Practice Address - Phone:202-331-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD13378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023385800Medicaid
DCP00184702Medicare Oscar/Certification
DCB94496Medicare UPIN
DC023385800Medicaid