Provider Demographics
NPI:1104812056
Name:LIVANI, ASDOLLAH (MD)
Entity type:Individual
Prefix:DR
First Name:ASDOLLAH
Middle Name:
Last Name:LIVANI
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:PO BOX 37189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3189
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:46045 PALISADE PKWY
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-8761
Practice Address - Country:US
Practice Address - Phone:703-430-4343
Practice Address - Fax:703-313-8865
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2023-11-27
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-20
Provider Licenses
StateLicense IDTaxonomies
VA0101244989207Q00000X
FLME0073595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8174OtherMEDICARE IDENTIFICATION NUMBER
FLK8174OtherMEDICARE IDENTIFICATION NUMBER