Provider Demographics
NPI:1518921691
Name:KOSMORSKY, PAUL MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:KOSMORSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:303 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5525
Mailing Address - Country:US
Mailing Address - Phone:215-860-1500
Mailing Address - Fax:215-860-7933
Practice Address - Street 1:303 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5525
Practice Address - Country:US
Practice Address - Phone:215-860-1500
Practice Address - Fax:215-860-7933
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007133L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA723247Medicare ID - Type Unspecified
PAF27707Medicare UPIN