Provider Demographics
NPI:1588987150
Name:JAMES OLIVER M.D., PC
Entity type:Organization
Organization Name:JAMES OLIVER M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-882-8866
Mailing Address - Street 1:5422 1ST PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5210
Mailing Address - Country:US
Mailing Address - Phone:202-882-8866
Mailing Address - Fax:202-882-2033
Practice Address - Street 1:5422 1ST PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5210
Practice Address - Country:US
Practice Address - Phone:202-882-8866
Practice Address - Fax:202-882-2033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES OLIVER M.D. PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011128800Medicaid
DC011128800Medicaid
DCD05902Medicare UPIN
DC036883P72Medicare PIN