Provider Demographics
NPI:1982673364
Name:AD, NIV (MD)
Entity Type:Individual
Prefix:DR
First Name:NIV
Middle Name:
Last Name:AD
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 1:7901 MAPLE AVE STE A
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6331
Mailing Address - Country:US
Mailing Address - Phone:202-524-4200
Mailing Address - Fax:
Practice Address - Street 1:7901 MAPLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6331
Practice Address - Country:US
Practice Address - Phone:202-524-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246383208600000X, 208G00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010111510Medicaid
VA010111510Medicaid
VA014831C44Medicare ID - Type Unspecified