Modjtabai, Khodadad
Modjtabai, Khodadad is an individual health care provider with primary practice located at 10802 Hickory Ridge Rd , Columbia MD 21044-3622. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Modjtabai, Khodadad can be contacted via phone (301) 997-1336.Contact Information
Primary practice address
10802 Hickory Ridge Rd
Columbia MD 21044-3622
Phone: (301) 997-1336
Fax: (410) 997-1636
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | DOO61559 | Maryland |
Profile Details
| NPI number | 1578567913 |
|---|---|
| LBN Legal business name | Modjtabai, Khodadad |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 13th, 2005 |
| Last updated | Oct 23rd, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578567913 | NPPES |
| Maryland | Other | MD0200488 | TRICARE |
| Maryland | Other | 1013399 | TRICARE |
| Maryland | Other | 243508 | TRICARE |
| Maryland | Other | P00287135 | TRICARE |
| Maryland | Other | 243208 | TRICARE |
| Maryland | Other | 5125212 | TRICARE |
| Maryland | Other | 9200455 | TRICARE |
| Maryland | MEDICAID | 7615905 | TRICARE |
| Maryland | Other | N1510002 | TRICARE |
| Maryland | Other | 1013399 | TRICARE |
| Maryland | Other | 2426820 | TRICARE |
| Maryland | Other | 243208 | TRICARE |
| Maryland | MEDICAID | 404889000 | TRICARE |
| Maryland | Other | 7305576 | TRICARE |
| Maryland | Other | 1142253 | TRICARE |
| Maryland | Other | 126480 | TRICARE |
| Maryland | Other | 3059165 | TRICARE |
| Maryland | Other | 5701 | TRICARE |
| Maryland | MEDICAID | 036555600 | TRICARE |
| Maryland | Other | 410823 | TRICARE |
| Maryland | Other | 5125212 | TRICARE |
| Maryland | Other | 64167401 | TRICARE |
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