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General NPI Number Information
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NPI Number | 1780468223
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Entity Type | Organization
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Legal Business Name | BIVINS FAMILY LLC
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 140 Q ST NE STE 100
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City | WASHINGTON
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State | DC
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Zip | 20002-2101
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Country | US
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Telephone | 202-636-9411
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Fax | 202-636-9415
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Provider Business Mailing Address
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Address Line | 1500 N GATE RD NW
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City | WASHINGTON
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State | DC
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Zip | 20012-1220
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Country | US
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Telephone | 202-288-9573
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | ANTHONY DERECK BIVINS
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Credential | MD
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Telephone | 202-288-9573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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