Organization
DRS TABOR & WEBER PA
Active
Other names
Drs Michetti Tabor & Weber PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL LAWRENCE MICHETTI DPM (PRESIDENT)
(301) 948-3668
Entity
Organization
Contact information
Practice address
702 RUSSELL AVE, SUITE 103, GAITHERSBURG, MD 20877-2606
(301) 948-3668
(301) 926-7787
Mailing address
702 RUSSELL AVE, SUITE 103, GAITHERSBURG, MD 20877-2606
(301) 948-3668
(301) 926-7787
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214348800
—
MD
01
—
7121
BCBS NCA
DC
01
—
KU36MI
BCBS MD
MD
Enumeration date
03/13/2007
Last updated
09/11/2019
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