Provider Demographics
NPI:1417987389
Name:KOSHY, KEVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:KOSHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MULLAMANGALAM
Other - Middle Name:C
Other - Last Name:KOSHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6 ESSEX CENTER DR.
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-531-0677
Mailing Address - Fax:978-531-5676
Practice Address - Street 1:6 ESSEX CENTER DR.
Practice Address - Street 2:SUITE 306
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-531-0677
Practice Address - Fax:978-531-5676
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39503207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2042193Medicaid
MAB97396Medicare UPIN
MA2042193Medicaid
D15017Medicare PIN