Healthcare Provider Details

I. General information

NPI: 1831310820
Provider Name (Legal Business Name): THE PHYSICIAN AND MIDWIFE COLLABORATIVE PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE SUITE 902
ALEXANDRIA VA
22304-1313
US

IV. Provider business mailing address

4660 KENMORE AVE SUITE 902
ALEXANDRIA VA
22304-1313
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-4300
  • Fax: 703-370-1683
Mailing address:
  • Phone: 703-370-4300
  • Fax: 703-370-1683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA DODSON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 443-398-0189