| Doctor Name: | DR. MICHAEL MATTHEW DICKMAN |
| NPI Number: | 1013013309 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | |
| Business Practice Address: | 9501 Farrell Rd Fort Belvoir, VA - 220605901 |
| Business Phone Number: | 7038050146 |
| Business Fax Number: | |
| Mailing Address: | 2503 Luckland Ln, WOODBRIDGE |
| State: | VA |
| Postal Code: | 221916347 |
| Phone Number: | 7033408285 |
| Fax Number: | |
| NPI Enumeration Date: | 09/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |