Healthcare Provider Details

I. General information

NPI: 1629988878
Provider Name (Legal Business Name): KAVEH AFSHAR DR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 BOILER HOUSE RD # 80H
PERRY POINT MD
21902-1103
US

IV. Provider business mailing address

4858 LEE HOLLOW PL
ELLICOTT CITY MD
21043-7991
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: