Provider Demographics
NPI:1528161445
Name:NILES, JOHN HERBERT JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HERBERT
Last Name:NILES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7500 GREENWAY CENTER DRIVE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-320-0315
Mailing Address - Fax:301-474-0800
Practice Address - Street 1:7500 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 620
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-474-5400
Practice Address - Fax:301-474-0800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0009397207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05429OtherAMERIGROUP
MDC61660Medicare UPIN
00B096P30Medicare ID - Type Unspecified