person
Dr. Khodadad Modjtabai, MD
Specialist in Columbia, Maryland
NPI 1578567913

Khodadad Modjtabai is a Specialist based in Ellicott City, MD. Khodadad Modjtabai practices in Columbia, MD and has the professional credentials of MD. The NPI Number for Khodadad Modjtabai is 1578567913 and holds a License No. DOO61559 (Maryland).

The current practice location address for Khodadad Modjtabai is 10802 Hickory Ridge Rd, Columbia, MD and can be reached out via phone at 301-997-1336 and via fax at 410-997-1636.

Location: 10802 Hickory Ridge Rd, Columbia, MD, 21042-6327
person
Provider Profile Details
NPI Number
1578567913
Provider Name
Khodadad Modjtabai
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
10802 Hickory Ridge Rd, Columbia, MD, 21042-6327
Phone Number
301-997-1336
Fax Number
410-997-1636
Provider Enumeration Date
06/13/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
MD0200488 01 MD TRICARE
1013399 01 MD ELDER HEALTH
243508 01 MD KAISER
P00287135 01 MD RAILROAD
243208 01 MD AMERIGROUP
5125212 01 MD MAMSI
9200455 01 MD EVERCARE
7615905 05 NC
N1510002 01 DC BLUE CROSS FEDERAL
1013399 01 VA FIRST HEALTH
2426820 01 MD UNITED HEALTHCARE
243208 01 MD AMERICAID
404889000 05 MD
7305576 01 MD AETNA OTHER
1142253 01 MD AETNA HMO
126480 01 MD JOHNS HOPKINS
3059165 01 MD CIGNA
5701 01 MD ELDER HEALTH
036555600 05 DC
410823 01 MD AMERICHOICE
5125212 01 MD ALLIANCE
64167401 01 MD BLUE CROSS OF MARYLAND
institution
Provider Business Practice Location Address Details
Address
10802 Hickory Ridge Rd
City
State
Zip
21044-3622
Phone Number
301-997-1336
Fax Number
410-997-1636
person
Provider Business Mailing Address Details
Address
10802 Hickory Ridge Rd
City
State
Zip
21044-3622
Phone Number
301-997-1336
Fax Number
410-997-1636
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
License No.
DOO61559 (Maryland)
Definition
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.
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