Provider Demographics
NPI:1730200155
Name:LAPLATA UROLOGY CENTER,LLC
Entity type:Organization
Organization Name:LAPLATA UROLOGY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR UROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKITELASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-392-0525
Mailing Address - Street 1:101 CENTENNIAL ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5975
Mailing Address - Country:US
Mailing Address - Phone:301-392-0525
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051225208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCK858OtherCARE FIRST BC BS DC
MD281CLAOtherCARE FIRST BC BS MD
MDDE0237Medicare PIN
MD281CLAOtherCARE FIRST BC BS MD