Provider Demographics
NPI:1508923186
Name:RICHARD A KOFF MD PC
Entity Type:Organization
Organization Name:RICHARD A KOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-357-9330
Mailing Address - Street 1:130 ALMSHOUSE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954
Mailing Address - Country:US
Mailing Address - Phone:215-357-9330
Mailing Address - Fax:215-357-4096
Practice Address - Street 1:130 ALMSHOUSE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954
Practice Address - Country:US
Practice Address - Phone:215-357-9330
Practice Address - Fax:215-357-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040042L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000734999 IBSOtherBLUE SHIELD
PA477183 BSOtherBLUE SHIELD
PA477183 BSOtherBLUE SHIELD
C34548Medicare UPIN