Provider Demographics
NPI:1124020060
Name:KOHUT, ROBERT LOUIS (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LOUIS
Last Name:KOHUT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 WESTPORT CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3229
Mailing Address - Country:US
Mailing Address - Phone:570-883-2228
Mailing Address - Fax:
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN509304-L163W00000X
NY858778367500000X
PARN509304L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03223501OtherCAPITAL ADVANTAGE
PA1345043OtherHIGHMARK
PA0073989170002Medicaid
PA11776579OtherCAQH
PA2037603000OtherIBC
PA50922OtherGEISINGER
PA1345043OtherFIRST PRIORITY
PA9213458OtherAETNA
PA1548332OtherGATEWAY
PA1548332OtherGATEWAY
PA430070498Medicare PIN
PA2037603000OtherIBC
PAS68453Medicare UPIN