Provider Demographics
NPI:1982665493
Name:KOEHLER, JAN O (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:O
Last Name:KOEHLER
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:PO BOX 60359
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0359
Mailing Address - Country:US
Mailing Address - Phone:843-237-3378
Mailing Address - Fax:843-237-5073
Practice Address - Street 1:420 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5046
Practice Address - Country:US
Practice Address - Phone:843-237-3378
Practice Address - Fax:843-237-5073
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000857207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC126K2OtherBCBS
NC89126K2Medicaid
NC89126K2Medicaid
P00262578Medicare PIN
P00248237Medicare PIN
2032773AMedicare PIN
NC2280586DMedicare PIN
NC2280586CMedicare PIN
NCA02056Medicare UPIN
NC2402309AMedicare PIN