Provider Demographics
NPI:1164582607
Name:ZYSKIND, AVIVA DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:DEBORAH
Last Name:ZYSKIND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 14TH ST NW
Mailing Address - Street 2:UPPER CARDOZO HEALTH CENTER
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6865
Mailing Address - Country:US
Mailing Address - Phone:202-745-4300
Mailing Address - Fax:202-299-1708
Practice Address - Street 1:3020 14TH ST NW
Practice Address - Street 2:UPPER CARDOZO HEALTH CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6865
Practice Address - Country:US
Practice Address - Phone:202-745-4300
Practice Address - Fax:202-299-1708
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD32269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4424440Medicaid
005559F41Medicare ID - Type Unspecified
DC4424440Medicaid