Healthcare Provider Details

I. General information

NPI: 1720058274
Provider Name (Legal Business Name): DAVID WILLIAM NIEBUHR MD, MPH, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 ROBERT GRANT AVE WALTER REED ARMY INST OF RESEARCH, DIV OF PREV MED
SILVER SPRING MD
20910-7500
US

IV. Provider business mailing address

19524 DUBARRY DR
BROOKEVILLE MD
20833-2616
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-9833
  • Fax: 301-319-9104
Mailing address:
  • Phone: 301-319-9833
  • Fax: 301-319-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101042399
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101042399
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: