Healthcare Provider Details

I. General information

NPI: 1609941624
Provider Name (Legal Business Name): VLADIMIR DEMIDOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/23/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3280
US

IV. Provider business mailing address

2001 MEDICAL PARKWAY
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1000
  • Fax:
Mailing address:
  • Phone: 443-481-1000
  • Fax: 443-481-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberD0054618
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0054618
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: