Healthcare Provider Details

I. General information

NPI: 1154584043
Provider Name (Legal Business Name): KISHAN J. KAPADIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S PACA ST 6TH FLOOR, SUITE 200
BALTIMORE MD
21201-1642
US

IV. Provider business mailing address

9388 ROCK RIPPLE LN
LAUREL MD
20723-5942
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8025
  • Fax: 410-328-8028
Mailing address:
  • Phone: 301-776-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB08295200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH0074093
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: