Provider Demographics
NPI:1861508954
Name:KOHLER, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:KOHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 YOUNGS FORD ROAD
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035
Mailing Address - Country:US
Mailing Address - Phone:610-664-6565
Mailing Address - Fax:610-660-8784
Practice Address - Street 1:1 BALA AVE
Practice Address - Street 2:SUITE 418
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3212
Practice Address - Country:US
Practice Address - Phone:610-664-6565
Practice Address - Fax:610-660-8784
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000232L171100000X
PAMD031995E208600000X
NJ25MA04461600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010281690001Medicaid
NJ085032OtherMEDICARE
NJ0712302Medicaid
NJ0712302Medicaid
PAB40354Medicare UPIN
NJ085032OtherMEDICARE