Provider Demographics
NPI:1407867856
Name:KOLIA, GULAM-MOHMED M (MD FACC)
Entity Type:Individual
Prefix:
First Name:GULAM-MOHMED
Middle Name:M
Last Name:KOLIA
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408-D SEVEN CORNERS PLACE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2011
Mailing Address - Country:US
Mailing Address - Phone:703-532-3298
Mailing Address - Fax:703-532-3299
Practice Address - Street 1:6408-D SEVEN CORNERS PLACE
Practice Address - Street 2:SUITE D
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2011
Practice Address - Country:US
Practice Address - Phone:703-532-3298
Practice Address - Fax:703-532-3299
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028377207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061470OtherANTHEM BCBS
VA006069827Medicaid
DC80450001OtherCAREFIRST BCBS
058257Medicare ID - Type Unspecified
VA006069827Medicaid