Individual provider Active NPI

Vladimir Demidov, MD

  • Geriatric Psychiatry Physician
  • Annapolis, MD
National Provider Identifier
1609941624
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
License
D0054618 Issued in MD
Practice address
2001 Medical Pkwy
Annapolis, MD 21401-3280
Phone
(443) 481-1000
NPI assigned
Nov 22, 2006
Last updated
Apr 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X D0054618 MD
Geriatric Psychiatry Physician 2084P0805X D0054618 MD Primary

Addresses

Primary practice location

2001 Medical Pkwy
Annapolis, MD 21401-3280

Mailing address

2001 Medical Parkway
Annapolis, MD 21401
Phone (443) 481-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140326000132 MD Practitioner - Psychiatry 2062454606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

175 Harry S Truman Pkwy
J. Kent McNew Family Medical Center
Annapolis, MD 21401-7573
Phone (443) 481-5400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0054618MDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC Current Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jan 4, 2014 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jan 4, 2014 Accepting new patients
Lucy Webb Hayes National Training School for Deaconsses & Missonaries Past Accepting new patients

Locations

175 Harry S Truman Pkwy
#J
Annapolis, MD 21401
Phone (443) 481-5400

2001 Medical Pkwy
Annapolis, MD 21401
Phone (410) 280-5601

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

2635 Riva Rd
Ste 108
Annapolis, MD 21401
Phone (410) 266-5790

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1609941624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 MEDICAL PARKWAY",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "21401",
            "telephone_number": "443-481-1000",
            "fax_number": "443-481-1271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 MEDICAL PKWY",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013280",
            "telephone_number": "443-481-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMIDOV",
        "first_name": "VLADIMIR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0054618",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MD",
            "license": "D0054618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

Verify at the official NPI Registry.