Healthcare Provider Details

I. General information

NPI: 1730672221
Provider Name (Legal Business Name): AMER KOWATLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN RD STE 60
ANNANDALE VA
22003-7337
US

IV. Provider business mailing address

3289 WOODBURN RD STE 60
ANNANDALE VA
22003-7337
US

V. Phone/Fax

Practice location:
  • Phone: 610-250-4375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number85064
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number0101285659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: