1609841188 NPI number — DR. MARY FREKKO KILAVOS M.D.

Table of content: DR. MARY FREKKO KILAVOS M.D. (NPI 1609841188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609841188 NPI number — DR. MARY FREKKO KILAVOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILAVOS
Provider First Name:
MARY
Provider Middle Name:
FREKKO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREKKO
Provider Other First Name:
MARY
Provider Other Middle Name:
ILONA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609841188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 WEST DIAMOND AVENUE
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-948-8780
Provider Business Mailing Address Fax Number:
301-519-9093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 WEST DIAMOND AVENUE
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-948-8780
Provider Business Practice Location Address Fax Number:
301-519-9093
Provider Enumeration Date:
02/20/2006

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: 207R00000X , with the licence number:  MD046987 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: D0062800 , 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: 492066 . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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