Provider Demographics
NPI:1679588503
Name:COSS, KATHLEEN MCKNIGHT (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MCKNIGHT
Last Name:COSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:166 OSWEGATCHIE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-235-5695
Mailing Address - Fax:
Practice Address - Street 1:75 GRANITE ST
Practice Address - Street 2:CHILD & FAMILY AGENCY
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-437-4550
Practice Address - Fax:860-437-4552
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0207112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E76825Medicare UPIN
260001717Medicare ID - Type Unspecified