Provider Demographics
NPI:1528036381
Name:DOUGLAS S COSLETT MD PC
Entity Type:Organization
Organization Name:DOUGLAS S COSLETT MD PC
Other - Org Name:VALLEY GYN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:COSLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-714-1444
Mailing Address - Street 1:24 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18708
Mailing Address - Country:US
Mailing Address - Phone:570-714-1444
Mailing Address - Fax:570-714-1488
Practice Address - Street 1:24 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1212
Practice Address - Country:US
Practice Address - Phone:570-714-1444
Practice Address - Fax:570-714-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA059559Medicare ID - Type Unspecified