Provider Demographics
NPI:1275633752
Name:KOSKO, JOANNA DOREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:DOREEN
Last Name:KOSKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:DOREEN
Other - Last Name:LUSK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 30637
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28230-0637
Mailing Address - Country:US
Mailing Address - Phone:704-973-5500
Mailing Address - Fax:
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-984-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70491207ZP0102X
FLME124961207ZP0102X
NC2009-00750207ZP0102X
SC36156207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2009-00750OtherSTATE LICENSE
SC36156OtherSTATE LICENSE