Provider Demographics
NPI:1346440526
Name:DHAR, NIVEDITA (MD)
Entity Type:Individual
Prefix:
First Name:NIVEDITA
Middle Name:
Last Name:DHAR
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 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:313-271-0430
Mailing Address - Fax:313-429-7941
Practice Address - Street 1:18100 OAKWOOD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4085
Practice Address - Country:US
Practice Address - Phone:313-271-0430
Practice Address - Fax:313-429-7941
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090181208800000X
MI4301092348208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2744641Medicaid
OHDH7372401Medicare PIN
MI0P30630558Medicare PIN