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NPI Code Detail

MEDICARE: GNANARAJ JOHNSON KOILPILLAI M.D.

MEDICARE: GNANARAJ JOHNSON KOILPILLAI M.D.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianD0057285MD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1211841OTHERMDMEDICARE PROVIDER #

General Provider Information

NPI Number : 1245218064
Entity Type Code : Individual
Provider Name (Legal Business Name) : GNANARAJ JOHNSON KOILPILLAI M.D.
Provider Business Mailing Address
First Line : PO BOX 37086
Second Line :
City : BALTIMORE
State : MD
Zip : 21297-3086
Country : US
Telephone Number : 240-439-8913
Fax Number : 240-439-8910
Provider Business Practice Location Address
First Line : 194 THOMAS JOHNSON DR
Second Line : SUITE A
City : FREDERICK
State : MD
Zip : 21702-4679
Country : US
Telephone Number : 240-215-6310
Fax Number : 240-566-7751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 07/30/2019

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