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NPI Code Detail

MEDICARE: SOLOMON MAPETO MUTETWA MD

MEDICARE: SOLOMON MAPETO MUTETWA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMT187984PA
2207Q00000XFamily Medicine Physician0101245581VA

General Provider Information

NPI Number : 1417146663
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOLOMON MAPETO MUTETWA MD
Provider Business Mailing Address
First Line : 5645 STONE RD
Second Line :
City : CENTREVILLE
State : VA
Zip : 20120-1618
Country : US
Telephone Number : 703-266-2442
Fax Number : 703-266-7159
Provider Business Practice Location Address
First Line : 111 S GROVE ST STE 1
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-1805
Country : US
Telephone Number : 304-257-2451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2007
Last Update Date : 03/17/2021

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Directions to “ SOLOMON MAPETO MUTETWA MD” Practice Location

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