Healthcare Provider Details

I. General information

NPI: 1518992692
Provider Name (Legal Business Name): MICHAEL DEUTSCH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 WELLFORD ST STE 100
FREDERICKSBURG VA
22401-3176
US

IV. Provider business mailing address

2800 WELLFORD ST STE 100
FREDERICKSBURG VA
22401-3176
US

V. Phone/Fax

Practice location:
  • Phone: 540-361-1830
  • Fax: 540-361-1829
Mailing address:
  • Phone: 540-361-1830
  • Fax: 540-361-1829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0117
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: