Provider Demographics
NPI:1760416739
Name:MICHEL, EDWARD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DAVID
Last Name:MICHEL
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 1:4424 COSTELLO WAY
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2996
Mailing Address - Country:US
Mailing Address - Phone:703-753-1895
Mailing Address - Fax:703-753-4630
Practice Address - Street 1:4424 COSTELLO WAY
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2996
Practice Address - Country:US
Practice Address - Phone:703-753-1895
Practice Address - Fax:703-753-4630
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0101228764208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00711Medicare UPIN