Healthcare Provider Details

I. General information

NPI: 1811981871
Provider Name (Legal Business Name): VINCENT JOEL MICHAUD MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E ST SW
WASHINGTON DC
20546
US

IV. Provider business mailing address

6304 BLACKBURN FORD DR
FAIRFAX STATION VA
22039-1226
US

V. Phone/Fax

Practice location:
  • Phone: 202-358-4719
  • Fax:
Mailing address:
  • Phone: 202-215-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberH6436
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: