Provider Demographics
NPI:1437679909
Name:KOBE, ETHAN (DO)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:KOBE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4395
Mailing Address - Country:US
Mailing Address - Phone:724-225-9970
Mailing Address - Fax:
Practice Address - Street 1:190 N MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4395
Practice Address - Country:US
Practice Address - Phone:724-225-9970
Practice Address - Fax:724-223-4253
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine