Healthcare Provider Details

I. General information

NPI: 1164440970
Provider Name (Legal Business Name): MYLES B KOBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 GOOD LUCK RD
LANHAM MD
20706
US

IV. Provider business mailing address

1100 MERCANTILE LANE SUITE 150
LARGO MD
20774
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-7990
  • Fax: 301-459-7993
Mailing address:
  • Phone: 301-249-0022
  • Fax: 301-249-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0047305
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: