Provider Demographics
NPI:1598394439
Name:KOSIK, GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:KOSIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WOODBINE LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8029
Mailing Address - Country:US
Mailing Address - Phone:570-271-8050
Mailing Address - Fax:570-271-5940
Practice Address - Street 1:16 WOODBINE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8029
Practice Address - Country:US
Practice Address - Phone:570-271-8050
Practice Address - Fax:570-271-5940
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT219958207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology