Healthcare Provider Details

I. General information

NPI: 1750726089
Provider Name (Legal Business Name): THE PHYSICIAN AND MIDWIFE COLLABORATIVE PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 FAIRFAX DR 500
ARLINGTON VA
22203-5860
US

IV. Provider business mailing address

4660 KENMORE AVE 902
ALEXANDRIA VA
22304-1313
US

V. Phone/Fax

Practice location:
  • Phone: 703-922-3434
  • Fax:
Mailing address:
  • Phone: 703-370-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101026374
License Number StateVA

VIII. Authorized Official

Name: DR. DAVID GIAMMITTORIO
Title or Position: CEO
Credential: MD
Phone: 703-490-9620