Provider Demographics
NPI:1184626681
Name:KOHLHEPP, WILLIAM CHARLES (PA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:KOHLHEPP
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 ELEANOR RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1239
Mailing Address - Country:US
Mailing Address - Phone:203-582-5226
Mailing Address - Fax:203-582-5303
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:ST RAPHAEL'S OCCUPATIONAL HEALTH PLUS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant