Provider Demographics
NPI:1780013508
Name:MULAI T YOHANNES MD PCCS MEDICAL LLC
Entity Type:Organization
Organization Name:MULAI T YOHANNES MD PCCS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MULAI
Authorized Official - Middle Name:T
Authorized Official - Last Name:YOHANNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-552-6666
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-0344
Mailing Address - Country:US
Mailing Address - Phone:301-552-6666
Mailing Address - Fax:301-552-6216
Practice Address - Street 1:9801 GREENBELT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2273
Practice Address - Country:US
Practice Address - Phone:301-552-6666
Practice Address - Fax:301-552-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD32123207RC0200X, 207RP1001X
MDD0059094207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5099242 00Medicaid
1334424OtherAETNA