MEDICARE: MICHAEL W DATCH M.D.

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
1	208000000X	Pediatrics Physician	D0012540	MD

General Provider Information

NPI Number	:	1528045051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL W DATCH M.D.

Provider Business Mailing Address
First Line	:	10301 GEORGIA AVE
Second Line	:	SUITE 106
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5020
Country	:	US
Telephone Number	:	301-681-6000
Fax Number	:	301-681-3153

Provider Business Practice Location Address
First Line	:	10301 GEORGIA AVE
Second Line	:	SUITE 106
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5020
Country	:	US
Telephone Number	:	301-681-6000
Fax Number	:	301-681-3153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	01/21/2009

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Directions to “ MICHAEL W DATCH M.D.” Practice Location

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