Provider Demographics
NPI:1508876327
Name:SOLTANI, KAVEH (DPM)
Entity Type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:
Last Name:SOLTANI
Suffix:
Gender:M
Credentials:DPM
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 15315
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-0315
Mailing Address - Country:US
Mailing Address - Phone:301-877-3493
Mailing Address - Fax:301-877-9510
Practice Address - Street 1:5867 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4570
Practice Address - Country:US
Practice Address - Phone:301-877-3493
Practice Address - Fax:301-877-9510
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01354213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD186885OtherAMERIGROUP PROVIDER #
MD4045068 00Medicaid
MD27-01087OtherUNITED HEALTHCARE
MD9810860002OtherCIGNA HMO PROVIDER #
MDG3250OtherBCBS PROVIDER #
MD3118195OtherAETNA HMO PROVIDER #
MD9810860001OtherCIGNA PPO PROVIDER #
MD480035183OtherRAILROAD MEDICARE
MD2104266OtherMAMSI PROVIDER #
MD7542422OtherAETNA PPO PROVIDER #
DC0342251 00Medicaid
MD279333OtherANTHEM BCBS PROVIDER#
MD491268Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
DC0342251 00Medicaid
MD2104266OtherMAMSI PROVIDER #