Basic Information
| Provider Information | |||||||||
| NPI: | 1003898271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLIA | ||||||||
| FirstName: | BASIRMOHMAD | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7704 MATAPEAKE BUSINESS DR STE 325 | ||||||||
| Address2: | |||||||||
| City: | BRANDYWINE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206133047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013737900 | ||||||||
| FaxNumber: | 3013736900 | ||||||||
| Practice Location | |||||||||
| Address1: | 7704 MATAPEAKE BUSINESS DR STE 325 | ||||||||
| Address2: | |||||||||
| City: | BRANDYWINE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206133047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013737900 | ||||||||
| FaxNumber: | 3013736900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0028035 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | D0028035 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 39143 | 01 | MD | MD-IPA | OTHER | 060002172 | 01 | MD | RAILROAD MEDICARE | OTHER | 4365 | 01 | DC | BCBS NCA | OTHER | 4957 | 01 | MD | BCBS MD | OTHER | 2106083 | 01 | MD | AETNA | OTHER | 792151900 | 05 | MD | MEDICAID | 89143 | 01 | MD | MD-IPA | OTHER |