Provider Demographics
NPI:1922690619
Name:KUMAPLEY K LARTEVI MD
Entity Type:Organization
Organization Name:KUMAPLEY K LARTEVI MD
Other - Org Name:CONVENIENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUMAPLEY
Authorized Official - Middle Name:KOFI
Authorized Official - Last Name:LARTEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-489-4146
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:202-902-7667
Mailing Address - Fax:301-889-9996
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:202-902-7667
Practice Address - Fax:301-889-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty