Provider Demographics
NPI:1760789846
Name:GULAM-MOHMED M KOLIA MD PC
Entity Type:Organization
Organization Name:GULAM-MOHMED M KOLIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GULAM-MOHMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACC
Authorized Official - Phone:703-532-3298
Mailing Address - Street 1:6408 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 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006069827Medicaid
8045-0001OtherCAREFIRST BCBS
061470OtherANTHEM BCBS
C89287Medicare UPIN