Healthcare Provider Details

I. General information

NPI: 1508974239
Provider Name (Legal Business Name): ROBERT W MICKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

2041 GEORGIA AVE NW STE 4308
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6611
  • Fax: 202-865-6212
Mailing address:
  • Phone: 202-865-3415
  • Fax: 202-865-6876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD13015
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: