Provider Demographics
NPI:1447335435
Name:FREEDMAN MITCHELL WHITTAKER AND WU MDS
Entity type:Organization
Organization Name:FREEDMAN MITCHELL WHITTAKER AND WU MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-461-0700
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 1210
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-461-0700
Mailing Address - Fax:703-461-0803
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 1210
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-461-0700
Practice Address - Fax:703-461-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
09850003OtherBCBS
889241OtherMAMSI HMO
289242OtherMAMSI PCP
09850001OtherBCBS
435495OtherANTHEM
0101055657OtherVA LICENSE
289241OtherMAMSI PCP
220421OtherANTHEM
286625OtherANTHEM
889242OtherMAMSI HMO
220421OtherANTHEM
286625OtherANTHEM
889242OtherMAMSI HMO
889242OtherMAMSI HMO
0101055657OtherVA LICENSE
BM5418125OtherDEA
889242OtherMAMSI HMO
G57866Medicare UPIN
289242OtherMAMSI PCP
803703Medicare ID - Type UnspecifiedGROUP #