Individual
DR. KHODADAD MODJTABAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10802 HICKORY RIDGE RD, COLUMBIA, MD 21044-3622
(301) 997-1336
(410) 997-1636
Mailing address
9784 OLD ANNAPOLIS RD, ELLICOTT CITY, MD 21042-6327
(410) 997-1336
(410) 997-1636
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
DOO61559
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036555600
—
DC
01
—
1013399
ELDER HEALTH
MD
01
—
1013399
FIRST HEALTH
VA
01
—
1142253
AETNA HMO
MD
01
—
126480
JOHNS HOPKINS
MD
01
—
2426820
UNITED HEALTHCARE
MD
01
—
243208
AMERIGROUP
MD
01
—
243508
KAISER
MD
01
—
3059165
CIGNA
MD
05
—
404889000
—
MD
01
—
410823
AMERICHOICE
MD
01
—
5125212
MAMSI
MD
01
—
5701
ELDER HEALTH
MD
01
—
64167401
BLUE CROSS OF MARYLAND
MD
01
—
7305576
AETNA OTHER
MD
05
—
7615905
—
NC
01
—
9200455
EVERCARE
MD
01
—
MD0200488
TRICARE
MD
01
—
N1510002
BLUE CROSS FEDERAL
DC
01
—
P00287135
RAILROAD
MD
Enumeration date
06/13/2005
Last updated
10/23/2012
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