Provider Demographics
NPI:1831156942
Name:KOUMBOURLIS, ANASTASSIOS CONSTANTIN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANASTASSIOS
Middle Name:CONSTANTIN
Last Name:KOUMBOURLIS
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:111 MICHIGAN AVE NW CHILDREN'S NATIONAL MEDICAL CENTER
Mailing Address - Street 2:DIVISION OF PULMONARY & SLEEP MEDICINE, SUITE 1030
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2970
Mailing Address - Country:US
Mailing Address - Phone:202-476-2642
Mailing Address - Fax:202-476-5864
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:CHILDREN'S NATIONAL MEDICAL CENTER, SUITE 1030
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-2642
Practice Address - Fax:202-476-5864
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2009-09-15
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Provider Licenses
StateLicense IDTaxonomies
NY1866932080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06283Medicare ID - Type Unspecified
E99755Medicare UPIN
NY01275901Medicare ID - Type Unspecified