1508876327 NPI number — DR. KAVEH SOLTANI DPM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508876327 NPI number — DR. KAVEH SOLTANI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLTANI
Provider First Name:
KAVEH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1508876327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20003-0315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-877-3493
Provider Business Mailing Address Fax Number:
301-877-9510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5867 ALLENTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUITLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20746-4570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-877-3493
Provider Business Practice Location Address Fax Number:
301-877-9510
Provider Enumeration Date:
08/08/2006

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: 213E00000X , with the licence number:  01354 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 186885 . This is a "AMERIGROUP PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4045068 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27-01087 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9810860002 . This is a "CIGNA HMO PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: G3250 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3118195 . This is a "AETNA HMO PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9810860001 . This is a "CIGNA PPO PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 480035183 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2104266 . This is a "MAMSI PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7542422 . This is a "AETNA PPO PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0342251 00 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 279333 . This is a "ANTHEM BCBS PROVIDER#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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