Provider Demographics
NPI:1568421501
Name:GEORGE M. KOSCO III, D.O. AND ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:GEORGE M. KOSCO III, D.O. AND ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOSCO, III
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-651-1515
Mailing Address - Street 1:2801 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3671
Mailing Address - Country:US
Mailing Address - Phone:717-651-1515
Mailing Address - Fax:717-651-1512
Practice Address - Street 1:2801 OLD POST RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3671
Practice Address - Country:US
Practice Address - Phone:717-651-1515
Practice Address - Fax:717-651-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006971L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA589805Medicare ID - Type Unspecified
PAF41753Medicare UPIN