Provider Demographics
NPI:1063479186
Name:KOSLOW, JOEL LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:LESTER
Last Name:KOSLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6355 WALKER LN
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3245
Mailing Address - Country:US
Mailing Address - Phone:703-971-0505
Mailing Address - Fax:703-971-0508
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 303
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-971-0505
Practice Address - Fax:703-971-0508
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101020388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB92992Medicare UPIN