1235143413 NPI number — DR. MARK G KOHN D.C.,

Table of content: DR. MARK G KOHN D.C., (NPI 1235143413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235143413 NPI number — DR. MARK G KOHN D.C.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHN
Provider First Name:
MARK
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235143413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3315 MAUCH CHUNK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPLAY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18037-2024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-769-7700
Provider Business Mailing Address Fax Number:
610-769-4701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 MAUCH CHUNK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COPLAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18037-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-769-7700
Provider Business Practice Location Address Fax Number:
610-769-4701
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC-006867-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02797200 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: KO 1599274 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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