Provider Demographics
NPI:1215901525
Name:SOLTANI, SEPEHR (MD)
Entity type:Individual
Prefix:DR
First Name:SEPEHR
Middle Name:
Last Name:SOLTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6188 OXON HILL RD STE 401
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3157
Mailing Address - Country:US
Mailing Address - Phone:301-567-4801
Mailing Address - Fax:301-567-3002
Practice Address - Street 1:6188 OXON HILL RD STE 401
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745
Practice Address - Country:US
Practice Address - Phone:301-567-4801
Practice Address - Fax:301-567-3002
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033601207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405061400Medicaid
MD405061400Medicaid
MD176115Medicare ID - Type Unspecified