Healthcare Provider Details

I. General information

NPI: 1710171061
Provider Name (Legal Business Name): MICHAEL JON PISHVAIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW BLDG B
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-6500
  • Fax: 202-660-6501
Mailing address:
  • Phone: 410-955-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD035033
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberS0972
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD71401
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: