Provider Demographics
NPI:1346274792
Name:KOST, JONATHAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:KOST
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:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06034-0448
Mailing Address - Country:US
Mailing Address - Phone:860-696-2843
Mailing Address - Fax:860-696-2845
Practice Address - Street 1:65 MEMORIAL RD
Practice Address - Street 2:SUITE 435
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-696-2843
Practice Address - Fax:860-696-2845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032267208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF33322Medicare UPIN
CT050000862Medicare ID - Type UnspecifiedMEDICARE ID
CT050000862Medicare PIN