Provider Demographics
NPI:1821067612
Name:KOESTER, ALAN R (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:KOESTER
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 1:1600 MEDICAL CENTER DRIVE
Mailing Address - Street 2:STE G500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-691-1262
Mailing Address - Fax:304-691-1666
Practice Address - Street 1:1600 MEDICAL CENTER DRIVE
Practice Address - Street 2:STE G500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-691-1262
Practice Address - Fax:304-691-1666
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043752207X00000X
NHLT2650207XS0106X, 207X00000X
WV23116207XS0117X, 207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011530Medicaid
KY7100048520Medicaid
OH2852453Medicaid
OH2852453Medicaid