Provider Demographics
NPI:1043356637
Name:AFSHAR, KIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIA
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S PRESIDENT ST
Mailing Address - Street 2:APT 1718
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4474
Mailing Address - Country:US
Mailing Address - Phone:410-493-4417
Mailing Address - Fax:
Practice Address - Street 1:5169 S COTTONWOOD ST STE 520
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6756
Practice Address - Country:US
Practice Address - Phone:801-507-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9002348-1205207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510711300Medicaid
MD181960Y82Medicare PIN