Provider Demographics
NPI:1518504752
Name:CHRISTINA L. CERVIERI MD LLC
Entity Type:Organization
Organization Name:CHRISTINA L. CERVIERI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CERVIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-821-3467
Mailing Address - Street 1:12020 WETHERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1111
Mailing Address - Country:US
Mailing Address - Phone:202-821-3467
Mailing Address - Fax:
Practice Address - Street 1:12020 WETHERFIELD LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1111
Practice Address - Country:US
Practice Address - Phone:202-821-3467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699932800Medicaid