Basic Information
Provider Information | |||||||||
NPI: | 1871711309 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAPOOR | ||||||||
FirstName: | VIKAS | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D, | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10110 MOLECULAR DR | ||||||||
Address2: | SUITE 206 | ||||||||
City: | ROCKVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 208507539 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3012792779 | ||||||||
FaxNumber: | 3012792767 | ||||||||
Practice Location | |||||||||
Address1: | 10110 MOLECULAR DR | ||||||||
Address2: | SUITE 206 | ||||||||
City: | ROCKVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 208507539 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3012792779 | ||||||||
FaxNumber: | 3012792767 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/22/2007 | ||||||||
LastUpdateDate: | 07/16/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 25MA08281600 | NJ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | D0072932 | MD | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
ID | Type | State | Issuer | Description | 0143413 | 05 | NJ |   | MEDICAID | 228476Y5K | 01 | DC | MEDICARE | OTHER | P00718274 | 01 | NJ | RAILROAD MEDICARE | OTHER |