Provider Demographics
NPI:1407083199
Name:KOUSARI, KAVEH (MD)
Entity Type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:KOUSARI
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 1:3 PENNS TRL
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1812
Mailing Address - Country:US
Mailing Address - Phone:609-303-4460
Mailing Address - Fax:609-303-4461
Practice Address - Street 1:2 CAPITAL WAY STE 407
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-303-4460
Practice Address - Fax:609-303-4461
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013400208600000X
NJ25MA10072800208800000X
PAMD451720208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery