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NPI Code Detail

MEDICARE: VIVIAN NDIRIKA DURU PA

MEDICARE: VIVIAN NDIRIKA DURU PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantC00004666MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1310866OTHERMDKAISER PERMANENTE
29774810OTHERMDAETNA PPO
38393492OTHERMDAETNA HMO

General Provider Information

NPI Number : 1447529904
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN NDIRIKA DURU PA
Provider Business Mailing Address
First Line : 7580 BUCKINGHAM BLVD STE 220
Second Line :
City : HANOVER
State : MD
Zip : 21076-3210
Country : US
Telephone Number : 410-729-5100
Fax Number :
Provider Business Practice Location Address
First Line : 24 MAGOTHY BEACH RD STE A
Second Line :
City : PASADENA
State : MD
Zip : 21122-4414
Country : US
Telephone Number : 410-255-2700
Fax Number : 410-437-1962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2011
Last Update Date : 03/22/2023

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Directions to “ VIVIAN NDIRIKA DURU PA” Practice Location

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