Provider Demographics
NPI:1902037336
Name:LARTEVI, KUMAPLEY KOFI I (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMAPLEY
Middle Name:KOFI
Last Name:LARTEVI
Suffix:I
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 1:1140 VARNUM ST NE STE 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2105
Mailing Address - Country:US
Mailing Address - Phone:202-489-4146
Mailing Address - Fax:202-464-5544
Practice Address - Street 1:1140 VARNUM ST NE STE 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2105
Practice Address - Country:US
Practice Address - Phone:202-560-5883
Practice Address - Fax:202-621-8029
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAFL3640895207Q00000X
MDD0077560207Q00000X
DCMD042176207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV8782AMedicare PIN
VA322678YWAUMedicare PIN