Provider Demographics
NPI:1427155076
Name:JAVANMARDI, NEZAM (DC)
Entity type:Individual
Prefix:DR
First Name:NEZAM
Middle Name:
Last Name:JAVANMARDI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5880
Mailing Address - Country:US
Mailing Address - Phone:202-882-4410
Mailing Address - Fax:202-882-4412
Practice Address - Street 1:3909 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5880
Practice Address - Country:US
Practice Address - Phone:202-882-4410
Practice Address - Fax:202-882-4412
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV08484Medicare UPIN
MD018982F04Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER