NPI 1104096361

Clinzo P. Mickle, MD

Practitioner Dermatology Physician Washington, DC

Practice location

Address: 650 Pennsylvania Ave SE Suite 420, Washington, DC 20003-4318
Phone: (202) 547-9001
Mailing address: 2400 16th St NW APT. 243, Washington, DC 20009-6646

Registered specialties

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X Licence MD036757 (DC)

Other Dermatology providers in District of Columbia →

Registry record

NPI: 1104096361
Entity type: Individual
Sex (as registered): Male
NPI issued: 4 Mar 2008
Record last updated: 6 Apr 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.