Provider Demographics
NPI:1275959371
Name:WASHINGTON NERVE INSTITUTE
Entity Type:Organization
Organization Name:WASHINGTON NERVE INSTITUTE
Other - Org Name:PLASTIC SURGERY NERVE & HEADACHE INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DOCTOR, PH.D
Authorized Official - Prefix:DR
Authorized Official - First Name:IVICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-992-9233
Mailing Address - Street 1:7601 LEWINSVILLE RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2814
Mailing Address - Country:US
Mailing Address - Phone:703-992-9233
Mailing Address - Fax:
Practice Address - Street 1:7601 LEWINSVILLE RD
Practice Address - Street 2:SUITE 460
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2814
Practice Address - Country:US
Practice Address - Phone:703-992-9233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD31470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011623G65Medicare UPIN