Healthcare Provider Details

I. General information

NPI: 1013013309
Provider Name (Legal Business Name): MICHAEL MATTHEW DICKMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP EXECUTIVE MEDICINE
FORT BELVOIR VA
22060
US

IV. Provider business mailing address

9300 DEWITT LOOP EXECUTIVE MEDICINE
FORT BELVOIR VA
22060
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-0540
  • Fax: 571-231-6697
Mailing address:
  • Phone: 571-231-0540
  • Fax: 571-231-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-1699
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: