1508876327 NPI number — DR. KAVEH SOLTANI DPM

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

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 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:

1508876327

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/24/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 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

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• 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" .

• 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".