Provider Demographics
NPI:1073832044
Name:SADEGHI, KAVEH (MD)
Entity Type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:SADEGHI
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:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20709-2510
Mailing Address - Country:US
Mailing Address - Phone:301-498-9494
Mailing Address - Fax:301-498-6301
Practice Address - Street 1:14113 BALTIMORE AVE STE A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:013-498-9494
Practice Address - Fax:301-498-6301
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246824207Q00000X
MDD0070134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD191435ZAKZMedicare PIN