Provider Demographics
NPI:1962676197
Name:JAMES MUTCHERSON, M.D., P.A. CHRTD.
Entity Type:Organization
Organization Name:JAMES MUTCHERSON, M.D., P.A. CHRTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUTCHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-269-4223
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 1:1140 VARNUM ST NE STE 30
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2152
Practice Address - Country:US
Practice Address - Phone:202-269-4223
Practice Address - Fax:202-269-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD7606207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC175733Medicare PIN