Provider Demographics
NPI:1255364105
Name:KO, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:KO
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 1:2005 CROFTON PL
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1543
Mailing Address - Country:US
Mailing Address - Phone:703-448-0842
Mailing Address - Fax:703-448-0842
Practice Address - Street 1:8133 LEESBURG PIKE
Practice Address - Street 2:SUITE 510
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2751
Practice Address - Country:US
Practice Address - Phone:703-291-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08039300207R00000X
MDD0071763207R00000X
VA0101256632207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD226602Medicare PIN