Provider Demographics
NPI:1003881871
Name:NIMETZ, ALLEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:A
Last Name:NIMETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-5050
Mailing Address - Fax:301-654-4237
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-5050
Practice Address - Fax:301-654-4237
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD007147207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
003573S12Medicare PIN
DC015389Medicare PIN
DCC61459Medicare UPIN
DCG01097Medicare ID - Type Unspecified