Healthcare Provider Details

I. General information

NPI: 1326268913
Provider Name (Legal Business Name): DIMITRI IARIKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 MOLECULAR DRIVE SUITE 105
ROCKVILLE MD
20850
US

IV. Provider business mailing address

10110 MOLECULAR DRIVE SUITE 105
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 301-605-7468
  • Fax: 301-605-7469
Mailing address:
  • Phone: 301-605-7468
  • Fax: 301-605-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0067787
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: