Provider Demographics
NPI:1720727753
Name:NIX DIRECT ACCESS PEDIATRICS PC
Entity Type:Organization
Organization Name:NIX DIRECT ACCESS PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIJANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-329-8292
Mailing Address - Street 1:7525 GREENWAY CENTER DR STE 215
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3525
Mailing Address - Country:US
Mailing Address - Phone:240-329-8292
Mailing Address - Fax:
Practice Address - Street 1:7525 GREENWAY CENTER DR STE 215
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3525
Practice Address - Country:US
Practice Address - Phone:240-329-8292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1043368756OtherNPI