Provider Demographics
NPI:1568527562
Name:KOCHERSPERGER, ALBERT BRUEN (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:BRUEN
Last Name:KOCHERSPERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NORTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1347
Mailing Address - Country:US
Mailing Address - Phone:607-336-1669
Mailing Address - Fax:607-334-6022
Practice Address - Street 1:110 NORTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1391
Practice Address - Country:US
Practice Address - Phone:607-334-5852
Practice Address - Fax:607-334-6022
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108711207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161004652K01OtherBC BS EXCELLUS
NY00573946Medicaid
NY34689BMedicare ID - Type Unspecified
NY00573946Medicaid