Healthcare Provider Details

I. General information

NPI: 1962088401
Provider Name (Legal Business Name): RANDY BAHIA AVIADO DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3450
  • Fax:
Mailing address:
  • Phone: 202-444-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberDO210012787
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: