Provider Demographics
NPI:1326173527
Name:LIVEZEY, VIVECA BHAT (MD)
Entity Type:Individual
Prefix:
First Name:VIVECA
Middle Name:BHAT
Last Name:LIVEZEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVECA
Other - Middle Name:
Other - Last Name:BHAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9309 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1620
Mailing Address - Country:US
Mailing Address - Phone:240-777-3131
Mailing Address - Fax:
Practice Address - Street 1:9309 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1620
Practice Address - Country:US
Practice Address - Phone:240-777-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD669362084N0400X
WAMD602329572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BT990OtherBLUE CROSS BLUE SHIELD
TX8BT990OtherBLUE CROSS BLUE SHIELD