Healthcare Provider Details

I. General information

NPI: 1538249297
Provider Name (Legal Business Name): MICHELE P. MAIBERGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

18000 SNOW CREEK DR
GAITHERSBURG MD
20877-3853
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8344
  • Fax:
Mailing address:
  • Phone: 301-258-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0061905
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: