Organization
THE PHYSICIAN AND MIDWIFE COLLABORATIVE PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID GIAMMITTORIO M.D. (CEO)
(703) 370-4300
Entity
Organization
Contact information
Practice address
12508 LAKE RIDGE DR, LAKE RIDGE, VA 22192-2354
(703) 491-1122
Mailing address
4660 KENMORE AVE, SUITE 902, ALEXANDRIA, VA 22304-1313
(703) 370-4300
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0101026374
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G00252
MEDICARE
VA
Enumeration date
01/03/2008
Last updated
01/03/2008
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