Provider Demographics
NPI:1043259658
Name:KOFSKY, PHILLIP MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MATTHEW
Last Name:KOFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 POWELL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3353
Mailing Address - Country:US
Mailing Address - Phone:610-272-3030
Mailing Address - Fax:610-279-6208
Practice Address - Street 1:1330 POWELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3353
Practice Address - Country:US
Practice Address - Phone:610-272-3030
Practice Address - Fax:610-279-6208
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-033961-E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA48466OtherKEYSTONE MERCY
PA0012103800002Medicaid
PAKO609035Medicare ID - Type UnspecifiedMEDICARE
PA0012103800002Medicaid