Healthcare Provider Details

I. General information

NPI: 1588812713
Provider Name (Legal Business Name): ZURAB NADAREISHVILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW SUITE 7-404, MFA, DEPARTMENT OF NEUROLOGY,
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW SUITE 7-404, MFA, DEPARTMENT OF NEUROLOGY,
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2700
  • Fax: 202-741-2721
Mailing address:
  • Phone: 202-741-2700
  • Fax: 202-741-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD038095
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: