Provider Demographics
NPI:1861506107
Name:DR. NI & ASSOCIATES,LLC
Entity Type:Organization
Organization Name:DR. NI & ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-261-8019
Mailing Address - Street 1:4218 RED FOX CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5721
Mailing Address - Country:US
Mailing Address - Phone:410-465-5820
Mailing Address - Fax:
Practice Address - Street 1:200 E 33RD ST STE 471
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3322
Practice Address - Country:US
Practice Address - Phone:410-261-8019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418691500Medicaid
MDH32788Medicare UPIN
MD418691500Medicaid