Provider Demographics
NPI:1518149046
Name:IYENGAR, KAVITA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:
Last Name:IYENGAR
Suffix:
Gender:F
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:P.O. BOX 64131
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4131
Mailing Address - Country:US
Mailing Address - Phone:443-481-6566
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:108 FORBES STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1501
Practice Address - Country:US
Practice Address - Phone:410-571-7880
Practice Address - Fax:410-571-0362
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070736207R00000X
MDD70736207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6350138OtherAETNA HMO
0008OtherCAREFIRST DC
9291577OtherAETNA PPO
MD540054600Medicaid
6493338OtherAETNA HMO SILVER SPRING
97179501OtherCAREFIRST MD (FORBES STREET)
97179502OtherCAREFIRST MD (PRINCE FREDERICK)
97179503OtherCAREFIRST MD (SILVER SPRING)
97179502OtherCAREFIRST MD (PRINCE FREDERICK)
97179503OtherCAREFIRST MD (SILVER SPRING)