Provider Demographics
NPI:1922191956
Name:MUTCHERSON, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MUTCHERSON
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 1:1140 VARNUM ST NE STE 30
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2152
Mailing Address - Country:US
Mailing Address - Phone:202-269-4223
Mailing Address - Fax:202-269-9406
Practice Address - Street 1:1150 VARNUM ST NE # 30
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2149
Practice Address - Country:US
Practice Address - Phone:202-269-4223
Practice Address - Fax:202-269-9406
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD7606207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC175733Medicare PIN
DCC88282Medicare UPIN