Healthcare Provider Details

I. General information

NPI: 1942284245
Provider Name (Legal Business Name): MICHELLE FLEETWOOD DVM, DACVP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AFIP BLDG 54 RM G117 DEPT VETERINARY PATHOLOGY 14TH ST AND ALASKA AVE, NW
WASHINGTON DC
20306-0001
US

IV. Provider business mailing address

4401 MAPLE AVE
BETHESDA MD
20814-4732
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-2442
  • Fax: 202-782-9150
Mailing address:
  • Phone: 301-654-0288
  • Fax: 202-782-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: