Provider Demographics
NPI:1790888220
Name:KOBYLSKI, THOMAS PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:KOBYLSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 JAVIER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4609
Mailing Address - Country:US
Mailing Address - Phone:301-703-2049
Mailing Address - Fax:301-309-2596
Practice Address - Street 1:3018 JAVIER RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4609
Practice Address - Country:US
Practice Address - Phone:301-703-2049
Practice Address - Fax:301-309-2596
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00420912084P0800X
VA01010438552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
018996J37Medicare ID - Type Unspecified