Provider Demographics
NPI:1184608382
Name:IAFOLLA, AYNE KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:AYNE
Middle Name:KIMBERLY
Last Name:IAFOLLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:POPOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 79061
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0061
Mailing Address - Country:US
Mailing Address - Phone:240-364-2510
Mailing Address - Fax:240-364-2539
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:NICU
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:301-279-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00509022080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4401530Medicaid
MD477007200Medicaid