DR. KHODADAD MODJTABAI M.D. NPI 1578567913

NPI Information

NPI: 1578567913
Provider Name: DR. KHODADAD MODJTABAI, M.D.
Classification: Specialist - 174400000X
Entity Type: Individual

PECOS Registration: Yes

Address:
10802 HICKORY RIDGE RD
COLUMBIA, MD
ZIP 21044
Phone: (301) 997-1336
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DR. Khodadad Modjtabai, M.D. is a specialist in Columbia, MD with 26 years of experience. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DR. Khodadad Modjtabai, M.D. NPI is 1578567913. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

10802 HICKORY RIDGE RD
COLUMBIA, MD
ZIP 21044-622
Phone: (301) 997-1336
Fax: (410) 997-1636

The NPI 1578567913 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/13/2005 and was last updated on 10/23/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		DOO61559	MARYLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1013399	OTHER	VIRGINIA	FIRST HEALTH
2	126480	OTHER	MARYLAND	JOHNS HOPKINS
3	410823	OTHER	MARYLAND	AMERICHOICE
4	5701	OTHER	MARYLAND	ELDER HEALTH
5	243508	OTHER	MARYLAND	KAISER
6	MD0200488	OTHER	MARYLAND	TRICARE
7	7615905	MEDICAID	NORTH CAROLINA
8	3059165	OTHER	MARYLAND	CIGNA
9	I08734	MEDICARE UPIN	MARYLAND
10	899M672M	MEDICARE ID-TYPE UNSPECIFIED	MARYLAND	HOWARD COUNTY
11	9200455	OTHER	MARYLAND	EVERCARE
12	404889000	MEDICAID	MARYLAND
13	1013399	OTHER	MARYLAND	ELDER HEALTH
14	243208	OTHER	MARYLAND	AMERICAID
15	5125212	OTHER	MARYLAND	MAMSI
16	64167401	OTHER	MARYLAND	BLUE CROSS OF MARYLAND
17	7305576	OTHER	MARYLAND	AETNA OTHER
18	2426820	OTHER	MARYLAND	UNITED HEALTHCARE
19	N1510002	OTHER	DISTRICT OF COLUMBIA	BLUE CROSS FEDERAL
20	P00287135	OTHER	MARYLAND	RAILROAD
21	1142253	OTHER	MARYLAND	AETNA HMO
22	243208	OTHER	MARYLAND	AMERIGROUP
23	5125212	OTHER	MARYLAND	ALLIANCE
24	036555600	MEDICAID	DISTRICT OF COLUMBIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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