1407867856 NPI number — GULAM-MOHMED M KOLIA MD FACC

Table of content: GULAM-MOHMED M KOLIA MD FACC (NPI 1407867856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407867856 NPI number — GULAM-MOHMED M KOLIA MD FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLIA
Provider First Name:
GULAM-MOHMED
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407867856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6408-D SEVEN CORNERS PLACE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22044-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-532-3298
Provider Business Mailing Address Fax Number:
703-532-3299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6408-D SEVEN CORNERS PLACE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22044-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-532-3298
Provider Business Practice Location Address Fax Number:
703-532-3299
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  0101028377 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 061470 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006069827 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80450001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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