Provider Demographics
NPI:1124024526
Name:KOUL, MOTI L (MD)
Entity Type:Individual
Prefix:
First Name:MOTI
Middle Name:L
Last Name:KOUL
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 1:4206 KIMBRELEE CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-3000
Mailing Address - Country:US
Mailing Address - Phone:703-799-0385
Mailing Address - Fax:
Practice Address - Street 1:4467 OLD BRANCH AVE
Practice Address - Street 2:STE 203
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1854
Practice Address - Country:US
Practice Address - Phone:301-899-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24020207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD79447-1300Medicaid
MDKO126901Medicare ID - Type Unspecified
MD79447-1300Medicaid