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General NPI Number Information
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NPI Number | 1780013508
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Entity Type | Organization
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Legal Business Name | MULAI T YOHANNES MD PCCS MEDICAL LLC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 9801 GREENBELT RD SUITE 101
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City | LANHAM
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State | MD
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Zip | 20706-2273
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Country | US
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Telephone | 301-552-6666
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Fax | 301-552-6216
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Provider Business Mailing Address
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Address Line | PO BOX 2344
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City | ARLINGTON
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State | VA
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Zip | 22202-0344
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Country | US
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Telephone | 301-552-6666
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Fax | 301-552-6216
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MULAI T YOHANNES
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Credential | M.D.
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Telephone | 301-552-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD32123
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | D0059094
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD32123
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License Number State | DC
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