Provider Demographics
NPI:1003898271
Name:KOLIA, BASIRMOHMAD F (MD)
Entity Type:Individual
Prefix:
First Name:BASIRMOHMAD
Middle Name:F
Last Name:KOLIA
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 1:7704 MATAPEAKE BUSINESS DR STE 325
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3047
Mailing Address - Country:US
Mailing Address - Phone:301-373-7900
Mailing Address - Fax:301-373-6900
Practice Address - Street 1:7704 MATAPEAKE BUSINESS DR STE 325
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3047
Practice Address - Country:US
Practice Address - Phone:301-373-7900
Practice Address - Fax:301-373-6900
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028035207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD39143OtherMD-IPA
MD060002172OtherRAILROAD MEDICARE
DC4365OtherBCBS NCA
MD4957OtherBCBS MD
MD2106083OtherAETNA
MD792151900Medicaid
MD89143OtherMD-IPA
MD4957OtherBCBS MD
MDC61849Medicare UPIN