MEDICARE: AMER KOWATLI

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
1	2085R0202X	Diagnostic Radiology Physician	85064	WV
2	2085R0202X	Diagnostic Radiology Physician	0101285659	VA
3	207U00000X	Nuclear Medicine Physician	0101285659	VA

General Provider Information

NPI Number	:	1730672221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMER KOWATLI

Provider Business Mailing Address
First Line	:	3289 WOODBURN RD STE 60
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-7337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3289 WOODBURN RD STE 60
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-7337
Country	:	US
Telephone Number	:	610-250-4375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	03/19/2026

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Directions to “ AMER KOWATLI ” Practice Location

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