Provider Demographics
NPI:1538152590
Name:OLIVER, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 1ST PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5210
Mailing Address - Country:US
Mailing Address - Phone:202-882-8866
Mailing Address - Fax:202-882-2033
Practice Address - Street 1:5422 1ST PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5210
Practice Address - Country:US
Practice Address - Phone:202-882-8866
Practice Address - Fax:202-882-2033
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD000025847207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011128800Medicaid
D05902Medicare UPIN
DC036883Medicare PIN
DC036883P72Medicare PIN