MEDICARE: DR. MINDA GAIL NIEBLAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	D0068102	MD
2	2083X0100X	Occupational Medicine Physician	0101054409	VA

General Provider Information

NPI Number	:	1427207653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINDA GAIL NIEBLAS M.D.

Provider Business Mailing Address
First Line	:	6801 ROCKLEDGE DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-1803
Country	:	US
Telephone Number	:	301-214-3069
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 ROCKLEDGE DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-1803
Country	:	US
Telephone Number	:	301-214-3069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/11/2008

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