Provider Demographics
NPI:1609972967
Name:KOSHY, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KOSHY
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 1:1860 BOY SCOUT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2119
Mailing Address - Country:US
Mailing Address - Phone:239-215-1180
Mailing Address - Fax:239-215-1179
Practice Address - Street 1:5325 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5534
Practice Address - Country:US
Practice Address - Phone:941-220-6263
Practice Address - Fax:386-490-9100
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME927952085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17238OtherBCBS OF FL
FL505100OtherWELLCARE
FLP00898040OtherRR MEDICARE
FLP983665OtherFREEDOM HEALTH
FLP01257637OtherRAILROAD MCR
FLP940526OtherOPTIMUM
FLPT091OtherMEDICARE
FL309040OtherAVMED
FL278934500Medicaid
FLP502151Medicaid
FLPT087OtherMEDICARE
FL7763556OtherAETNA
FLP00421717OtherRAILROAD MEDICARE
FL17238OtherBCBS
FL3446756OtherCIGNA
FLAE244LMedicare PIN
FLAE244KMedicare PIN
FLP940526OtherOPTIMUM
FLP00421717OtherRAILROAD MEDICARE
FLAE244DMedicare PIN
FLP983665OtherFREEDOM HEALTH
FL7763556OtherAETNA
FL505100OtherWELLCARE
FLAE244TMedicare PIN
FLAE244EMedicare PIN
FL309040OtherAVMED
FLAE244QMedicare PIN
FLAE244SMedicare PIN
FLAE244CMedicare PIN
FLP01257637OtherRAILROAD MCR
FLAE244XMedicare PIN
FLAE244OMedicare PIN