Provider Demographics
NPI:1073998357
Name:MATLI, VENKATA VINOD KUMAR (MD,)
Entity Type:Individual
Prefix:DR
First Name:VENKATA VINOD KUMAR
Middle Name:
Last Name:MATLI
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 1:3001 HOSPITAL DR
Mailing Address - Street 2:5TH FLOOR DEPT OF INTERNAL MEDICINE
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1189
Mailing Address - Country:US
Mailing Address - Phone:301-618-3776
Mailing Address - Fax:301-618-2986
Practice Address - Street 1:3001 HOSPITAL DR
Practice Address - Street 2:5TH FLOOR DEPT OF INTERNAL MEDICINE
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1189
Practice Address - Country:US
Practice Address - Phone:301-618-3776
Practice Address - Fax:301-618-2986
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA310977207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program