Provider Demographics
NPI:1619065448
Name:DIWANI, SELWA JAWAD (MD)
Entity Type:Individual
Prefix:
First Name:SELWA
Middle Name:JAWAD
Last Name:DIWANI
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 1:4900 SILVER HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746
Mailing Address - Country:US
Mailing Address - Phone:301-735-2300
Mailing Address - Fax:301-735-0678
Practice Address - Street 1:4900 SILVER HILL ROAD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746
Practice Address - Country:US
Practice Address - Phone:301-735-2300
Practice Address - Fax:301-735-0678
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD-039713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF05838Medicare UPIN
MD00A704T27Medicare PIN