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NPI Code Detail

MEDICARE: DR. JOHN NICHOLAS VAN DAM MD

MEDICARE: DR. JOHN NICHOLAS VAN DAM MD
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
1207Q00000XFamily Medicine PhysicianMD11962DC
2207Q00000XFamily Medicine PhysicianD30583MD

Other Identifiers

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

General Provider Information

NPI Number : 1730108788
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN NICHOLAS VAN DAM MD
Provider Business Mailing Address
First Line : 8116 GOOD LUCK RD STE 305
Second Line :
City : LANHAM
State : MD
Zip : 20706-3508
Country : US
Telephone Number : 301-552-1200
Fax Number : 301-552-2611
Provider Business Practice Location Address
First Line : 5801 ALLENTOWN RD STE 400
Second Line :
City : CAMP SPRINGS
State : MD
Zip : 20746-4585
Country : US
Telephone Number : 301-868-0150
Fax Number : 301-868-0243
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/21/2022

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Directions to “ DR. JOHN NICHOLAS VAN DAM MD” Practice Location

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