Provider Demographics
NPI:1164446167
Name:KOHLI, SANJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:
Last Name:KOHLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 OPITZ BLVD STE 335
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3340
Mailing Address - Country:US
Mailing Address - Phone:703-492-6726
Mailing Address - Fax:703-492-2400
Practice Address - Street 1:2200 OPITZ BLVD STE 335
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3340
Practice Address - Country:US
Practice Address - Phone:703-492-6726
Practice Address - Fax:703-492-2400
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-056380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110008212Medicare PIN