Provider Demographics
NPI:1942268354
Name:KOSCHMANN, FAITH L (MD)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:L
Last Name:KOSCHMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:FAITH
Other - Middle Name:L
Other - Last Name:IVANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:690 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9518
Mailing Address - Country:US
Mailing Address - Phone:503-845-2000
Mailing Address - Fax:503-845-2384
Practice Address - Street 1:690 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9518
Practice Address - Country:US
Practice Address - Phone:503-845-2000
Practice Address - Fax:503-845-2384
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027907Medicaid
135930Medicare UPIN
OR027907Medicaid