Provider Demographics
NPI:1932107836
Name:HENDI, NIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:HENDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 TANEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4747
Mailing Address - Country:US
Mailing Address - Phone:301-662-0133
Mailing Address - Fax:240-379-6710
Practice Address - Street 1:1475 TANEY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4747
Practice Address - Country:US
Practice Address - Phone:301-662-0133
Practice Address - Fax:240-379-6710
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00543122080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD456302600Medicaid