Healthcare Provider Details

I. General information

NPI: 1073960951
Provider Name (Legal Business Name): MANI YAVI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MANI YAHYAVI-TAJABADI MD

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

PO BOX 90921
WASHINGTON DC
20090-0921
US

V. Phone/Fax

Practice location:
  • Phone: 301-605-5153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101273914
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD048481
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: