Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | MD13242 | VA |
NPI | 1265528988 |
---|---|
Provider Name | Dr. Michael Dimattina |
First Address | Arlington, VA 22204 |
Second Address | Arlington, VA 22204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F88902 | (02) | VA |