Healthcare Provider Details

I. General information

NPI: 1124136775
Provider Name (Legal Business Name): MICHAEL Y. MCCOWN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVE. N.W.
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVE. N.W.
WASHINGTON DC
20307-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-4211
  • Fax:
Mailing address:
  • Phone: 202-782-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102201428
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: