Provider Demographics
NPI:1033433552
Name:JONATHAN KIEV MD PA LLC
Entity Type:Organization
Organization Name:JONATHAN KIEV MD PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-503-2609
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-0669
Mailing Address - Country:US
Mailing Address - Phone:877-503-2609
Mailing Address - Fax:410-286-5442
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:STE 660
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:877-503-2609
Practice Address - Fax:410-286-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066881208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407175100Medicaid