MEDICARE: NIX DIRECT ACCESS PEDIATRICS PC

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	2080A0000X	Pediatric Adolescent Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1043368756	OTHER	MD	NPI

General Provider Information

NPI Number	:	1720727753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIX DIRECT ACCESS PEDIATRICS PC

Provider Business Mailing Address
First Line	:	10274 LAKE ARBOR WAY STE 201
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-3146
Country	:	US
Telephone Number	:	301-823-5999
Fax Number	:	301-823-5990

Provider Business Practice Location Address
First Line	:	10274 LAKE ARBOR WAY STE 201
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-3146
Country	:	US
Telephone Number	:	301-823-5999
Fax Number	:	301-823-5990

Authorized Official
Title or Position	:	CEO
Name	:	KIJANA N NIX
Credential	:	MD
Telephone Number	:	301-823-5999

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	08/02/2024

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Directions to “NIX DIRECT ACCESS PEDIATRICS PC ” Practice Location

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