Provider Demographics
NPI:1083649511
Name:KOKROO MEDICAL ASSOCIATES,PC
Entity Type:Organization
Organization Name:KOKROO MEDICAL ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKROO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-707-9311
Mailing Address - Street 1:328 MERION PL
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1642
Mailing Address - Country:US
Mailing Address - Phone:215-579-4480
Mailing Address - Fax:215-579-1229
Practice Address - Street 1:100 E LEHIGH AVE
Practice Address - Street 2:MAB SUITE 109
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1012
Practice Address - Country:US
Practice Address - Phone:215-707-9311
Practice Address - Fax:215-579-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070944L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty