Healthcare Provider Details

I. General information

NPI: 1396775441
Provider Name (Legal Business Name): JEFFREY ROBERT LIVEZEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE
WASHINGTON DC
20307-5001
US

IV. Provider business mailing address

8113 SHOAL CREEK DR
LAUREL MD
20724-2949
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0064500
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: