Provider Demographics
NPI:1548767601
Name:KOLKIN, ALEXANDER VANCE
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:VANCE
Last Name:KOLKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IRVING ST NW
Mailing Address - Street 2:DEPT OF EMERGENCY MEDICINE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:202-877-8080
Mailing Address - Fax:202-877-7633
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-8080
Practice Address - Fax:202-877-7633
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD91232207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine