Provider Demographics
NPI:1659478709
Name:KOHLI, DEBORAH H (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:H
Last Name:KOHLI
Suffix:
Gender:F
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:PO BOX 11650
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5650
Mailing Address - Country:US
Mailing Address - Phone:206-842-1819
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL BREMERTON, FAMILY PRACTICE CLINIC
Practice Address - Street 2:1 BOONE RD
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1898
Practice Address - Country:US
Practice Address - Phone:360-475-4345
Practice Address - Fax:360-475-4512
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8434268Medicaid
WA8434268Medicaid