Provider Demographics
NPI:1407830268
Name:DAVID, VIVEK (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7799 LEESBURG PIKE
Mailing Address - Street 2:SUITE 1000 N
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2408
Mailing Address - Country:US
Mailing Address - Phone:703-667-8600
Mailing Address - Fax:703-667-8610
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:SUITE 106
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3622
Practice Address - Country:US
Practice Address - Phone:202-966-0606
Practice Address - Fax:202-244-6757
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD311992085R0202X
MDD00536082085R0202X
VAO1010582852085R0202X
WAMD000439822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
470001526OtherRR MEDICARE
300135375OtherRR MEDICARE
MD086500100Medicaid
300135375OtherRR MEDICARE
DC00B421O31Medicare PIN
DC007440W30Medicare PIN
G37373Medicare UPIN
470001526OtherRR MEDICARE