Healthcare Provider Details

I. General information

NPI: 1720982671
Provider Name (Legal Business Name): DMITRI MATTHEW M ZISCHKE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 RANDOLPH AVE
CAPE CHARLES VA
23310-3305
US

IV. Provider business mailing address

515 RANDOLPH AVE
CAPE CHARLES VA
23310-3305
US

V. Phone/Fax

Practice location:
  • Phone: 571-355-3913
  • Fax:
Mailing address:
  • Phone: 571-355-3913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF09261678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: