Healthcare Provider Details

I. General information

NPI: 1538976774
Provider Name (Legal Business Name): JOSHUA KOLBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

3235 CATLIN AVE
QUANTICO VA
22134-5109
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1725
  • Fax:
Mailing address:
  • Phone: 703-784-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110011164
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: