1295812899 NPI number — DR. KHOSROW DAVACHI MD

Table of content: DR. KHOSROW DAVACHI MD (NPI 1295812899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295812899 NPI number — DR. KHOSROW DAVACHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVACHI
Provider First Name:
KHOSROW
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295812899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 OLD BRANCH AVE
Provider Second Line Business Mailing Address:
STE D203
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-1611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-868-7121
Provider Business Mailing Address Fax Number:
301-868-7968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 OLD BRANCH AVE STE D203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-868-7121
Provider Business Practice Location Address Fax Number:
301-868-7968
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  D0025640 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: MD8172 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0400742 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0400741 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 22594 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 417465 . This is a "MDIPA/OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 022838200 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205102800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0771 0001 . This is a "BLUE CHOICE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0771 0001 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 110186422 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1212 . This is a "ELDER HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27555 . This is a "PRIORITY PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 409013349 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 30859001 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4954 . This is a "HEALTHRITE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 097999 . This is a "BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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