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General NPI Number Information
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NPI Number | 1477896934
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Entity Type | Individual
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Provider Name | DAVID ITSKEVICH D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 08/04/2024
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Provider Practice Location Address
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Address Line | 9420 KEY WEST AVE STE 325
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City | ROCKVILLE
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State | MD
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Zip | 20850-6529
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Country | US
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Telephone | 301-363-9693
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Fax | 301-363-9676
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Provider Business Mailing Address
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Address Line | 9420 KEY WEST AVE STE 325
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City | ROCKVILLE
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State | MD
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Zip | 20850-6529
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Country | US
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Telephone | 301-363-9693
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Fax | 301-363-9676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | H83590
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License Number State | MD
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