Provider Demographics
NPI:1578584512
Name:SANJEEV KOHLI, MD PC
Entity Type:Organization
Organization Name:SANJEEV KOHLI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-492-6726
Mailing Address - Street 1:4660 KENMORE AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1383
Mailing Address - Country:US
Mailing Address - Phone:703-824-9399
Mailing Address - Fax:703-931-0059
Practice Address - Street 1:4660 KENMORE AVE STE 900
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1383
Practice Address - Country:US
Practice Address - Phone:703-824-9399
Practice Address - Fax:703-931-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-056380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG15921Medicare UPIN
VA110008212Medicare PIN