Provider Demographics
NPI:1700882297
Name:KAKITELASHVILI, VLADIMIR (MD)
Entity type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:KAKITELASHVILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ELKRIDGE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2924
Mailing Address - Country:US
Mailing Address - Phone:301-609-4695
Mailing Address - Fax:301-392-0458
Practice Address - Street 1:101 CENTENNIAL ST
Practice Address - Street 2:SUITE E
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5975
Practice Address - Country:US
Practice Address - Phone:301-392-0525
Practice Address - Fax:301-392-0458
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057225208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2249341OtherUNITED HC/AMERICHOICE
MD1095167OtherAETNA HMO/POS
MD827840OtherJOHNS HOPKINS GROUP #
MD1552286OtherCIGNA
MD616119-04OtherCARE FIRST BC/BS
MD7801404OtherAETNA ELECT CHOICE
610737600OtherFED WORKERS COMP - OWCP
MD85484OtherAMERIGROUP
MD510328200Medicaid
MD827840OtherJOHNS HOPKINS GROUP #
MDH73150Medicare UPIN
MD510328200Medicaid