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General NPI Number Information
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NPI Number | 1730200155
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Entity Type | Organization
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Legal Business Name | LAPLATA UROLOGY CENTER,LLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 101 CENTENNIAL ST SUITE E
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City | LA PLATA
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State | MD
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Zip | 20646-5975
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Country | US
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Telephone | 301-392-0525
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Fax | 301-392-0458
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Provider Business Mailing Address
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Address Line | 101 CENTENNIAL ST SUITE E
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City | LA PLATA
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State | MD
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Zip | 20646-5975
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Country | US
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Telephone | 301-392-0525
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Fax | 301-392-0458
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Authorized Official
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Title or Position | MEDICAL DOCTOR UROLOGY
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Name | DR. VLADIMIR KAKITELASHVILI
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Credential | M.D.
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Telephone | 301-392-0525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | D0051225
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License Number State | MD
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