Healthcare Provider Details

I. General information

NPI: 1265528988
Provider Name (Legal Business Name): MICHAEL DIMATTINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 SOUTH GLEBE ROAD #301
ARLINGTON VA
22204
US

IV. Provider business mailing address

46 SOUTH GLEBE ROAD #301
ARLINGTON VA
22204
US

V. Phone/Fax

Practice location:
  • Phone: 703-920-3890
  • Fax: 703-892-6037
Mailing address:
  • Phone: 703-920-3890
  • Fax: 703-892-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD13242
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: