MEDICARE: SANJEEV KOHLI, MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207K00000X	Allergy & Immunology Physician
2	207R00000X	Internal Medicine Physician
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1023381506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANJEEV KOHLI, MD PC

Provider Business Mailing Address
First Line	:	3450 N BEAUREGARD ST
Second Line	:	SUITE 1
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1200
Country	:	US
Telephone Number	:	703-820-7000
Fax Number	:	703-820-5564

Provider Business Practice Location Address
First Line	:	3450 N BEAUREGARD ST
Second Line	:	SUITE 1
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1200
Country	:	US
Telephone Number	:	703-820-7000
Fax Number	:	703-820-5564

Authorized Official
Title or Position	:	OWNER
Name	:	SANJEEV KOHLI
Credential	:	M.D.
Telephone Number	:	703-820-7000

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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