Provider Demographics
NPI:1669417267
Name:RAFEI, KEYVAN (MD)
Entity type:Individual
Prefix:
First Name:KEYVAN
Middle Name:
Last Name:RAFEI
Suffix:
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 1:10380 OLD COLUMBIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2005
Mailing Address - Country:US
Mailing Address - Phone:405-060-7392
Mailing Address - Fax:
Practice Address - Street 1:10380 OLD COLUMBIA RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2005
Practice Address - Country:US
Practice Address - Phone:443-492-4000
Practice Address - Fax:443-492-4010
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD586192080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022004300Medicaid
MD400788300Medicaid
MD022004300Medicaid
MD988LJ535Medicare PIN
MD400788300Medicaid