Healthcare Provider Details

I. General information

NPI: 1811093727
Provider Name (Legal Business Name): HOUTAN ADIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC 50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

9405 ALTHEA CT
POTOMAC MD
20854-3003
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8647
  • Fax: 202-745-2269
Mailing address:
  • Phone: 202-745-8647
  • Fax: 202-745-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD17649
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number010134984
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: