Provider Demographics
NPI:1710917588
Name:KOSHY, GEORGE MATTHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MATTHEN
Last Name:KOSHY
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 1:2000 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3073
Mailing Address - Country:US
Mailing Address - Phone:954-839-8080
Mailing Address - Fax:954-839-8081
Practice Address - Street 1:2000 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3073
Practice Address - Country:US
Practice Address - Phone:954-839-8080
Practice Address - Fax:954-839-8081
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME961372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMEDICAL LICENSEOtherME96137