Provider Demographics
NPI:1720192677
Name:KOFF, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:KOFF
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 1:2840 PINE RD UNIT D1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4242
Mailing Address - Country:US
Mailing Address - Phone:215-464-6383
Mailing Address - Fax:215-464-2663
Practice Address - Street 1:2840 PINE RD UNIT D1
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-464-6383
Practice Address - Fax:215-464-2663
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040042L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000734999 BSOtherBLUE SHIELD
PA477183 BSOtherBLUE SHIELD
PA000734999 BSOtherBLUE SHIELD
PA477183 BSOtherBLUE SHIELD