Provider Demographics
NPI:1306855390
Name:LITVAK, JUAN PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PABLO
Last Name:LITVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25 CROSSROADS DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:443-738-2872
Mailing Address - Fax:
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:#503
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-530-1700
Practice Address - Fax:301-530-0418
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035370208800000X
MDD0062602208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407623100Medicaid
H83524Medicare UPIN
016919U22Medicare ID - Type Unspecified
3199524OtherAETNA US HEALTHCARE HMO
7549472OtherAETNA US HEALTHCARE PIN
1900687OtherUNITED HEALTHCARE EVERCAR
H83524Medicare UPIN
182863OtherVA BS ANTHEM GERMANTOWN
2293138OtherUNITED HEALTHCARE
DC0202OtherCAREFIRST BCBS
7516413OtherCIGNA
174612OtherVA BS ANTHEM BETHESDA
016919U22Medicare ID - Type Unspecified
KD82UROtherCAREFIRST BCBS
104747OtherLOCAL 825
2103641OtherFIRST HEALTH CCN
2130137OtherMAMSI