Provider Demographics
NPI:1023381506
Name:SANJEEV KOHLI, MD PC
Entity Type:Organization
Organization Name:SANJEEV KOHLI, MD PC
Other - Org Name:BEAUREGARD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-820-7000
Mailing Address - Street 1:3450 N BEAUREGARD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1200
Mailing Address - Country:US
Mailing Address - Phone:703-820-7000
Mailing Address - Fax:703-820-5564
Practice Address - Street 1:3450 N BEAUREGARD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1200
Practice Address - Country:US
Practice Address - Phone:703-820-7000
Practice Address - Fax:703-820-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty