Provider Demographics
NPI:1356353411
Name:MICHEL, ERNEST LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LEE
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 1:1139 E HIGH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4855
Mailing Address - Country:US
Mailing Address - Phone:434-817-8484
Mailing Address - Fax:
Practice Address - Street 1:3998 FAIR RIDGE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2921
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232152-1207L00000X
VA0101238028207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK142-0001OtherCAREFIRST 2005
VA298098OtherAMERIGROUP
VA066579OtherANTHEM
VA1356353411Medicaid
VA484645OtherNCPPO
VA9340524OtherPHCS
DC018516F89Medicare ID - Type Unspecified
VA009201F81Medicare ID - Type Unspecified
VA1356353411Medicaid