MEDICARE: MIRIAM NIKTASH DPM

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
1	213E00000X	Podiatrist	0103301436	VA
2	213E00000X	Podiatrist	01809	MD

General Provider Information

NPI Number	:	1457927196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM NIKTASH DPM

Provider Business Mailing Address
First Line	:	6316 DEMOCRACY BLVD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-1664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6316 DEMOCRACY BLVD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-1664
Country	:	US
Telephone Number	:	301-363-2676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	04/11/2026

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