Basic Information
| Provider Information | |||||||||
| NPI: | 1518149046 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IYENGAR | ||||||||
| FirstName: | KAVITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 64131 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816566 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 FORBES STREET | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214011501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105717880 | ||||||||
| FaxNumber: | 4105710362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0070736 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | D70736 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 6350138 | 01 | AETNA HMO | OTHER | 0008 | 01 | CAREFIRST DC | OTHER | 9291577 | 01 | AETNA PPO | OTHER | 540054600 | 05 | MD | MEDICAID | 6493338 | 01 | AETNA HMO SILVER SPRING | OTHER | 97179501 | 01 | CAREFIRST MD (FORBES STREET) | OTHER | 97179502 | 01 | CAREFIRST MD (PRINCE FREDERICK) | OTHER | 97179503 | 01 | CAREFIRST MD (SILVER SPRING) | OTHER |