Provider Demographics
NPI:1669815734
Name:MICHAELSON, MICHAEL GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GARY
Last Name:MICHAELSON
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 1:2939 VAN NESS ST NW
Mailing Address - Street 2:SUITE 618
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4662
Mailing Address - Country:US
Mailing Address - Phone:202-362-2699
Mailing Address - Fax:
Practice Address - Street 1:2939 VAN NESS ST NW
Practice Address - Street 2:SUITE 618
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4622
Practice Address - Country:US
Practice Address - Phone:202-362-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD15031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine