Healthcare Provider Details

I. General information

NPI: 1922688522
Provider Name (Legal Business Name): KELI KOBLA DOE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

9418 WINDSOR WAY
BURKE VA
22015-4541
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax:
Mailing address:
  • Phone: 703-537-6159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: