Provider Demographics
NPI:1972570646
Name:AKTAY, ATIYE (MD)
Entity type:Individual
Prefix:
First Name:ATIYE
Middle Name:
Last Name:AKTAY
Suffix:
Gender:F
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:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:22 S GREENE ST # N5W40
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-7373
Practice Address - Fax:410-328-7305
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39262020207RG0100X
MDD867132080P0206X
OH35090720207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH421769OtherWELLCARE
OH5434452OtherAETNA
OH752760OtherBUCKEYE
OH000000230990OtherUNISON
PA1023728120001Medicaid
WI32523600Medicaid
OH000000550668OtherANTHEM
OH2781566Medicaid
OHAK4226631Medicare PIN
OHAD4146177Medicare PIN
OH752760OtherBUCKEYE
OH000000230990OtherUNISON
WI004573844Medicare ID - Type UnspecifiedMEDICARE