Provider Demographics
NPI:1184936742
Name:KOSCINSKI, ERIN ANDREA (DO)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:ANDREA
Last Name:KOSCINSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 CAMPUS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9703
Mailing Address - Country:US
Mailing Address - Phone:276-628-1186
Mailing Address - Fax:276-628-8507
Practice Address - Street 1:613 CAMPUS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9703
Practice Address - Country:US
Practice Address - Phone:276-628-1186
Practice Address - Fax:276-628-8507
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203582207Q00000X
TN2539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002320Medicaid
VA1184936742Medicaid
NC1184936742Medicaid
TN1532822Medicaid
VAVVD951AMedicare PIN
TN103I084868Medicare PIN
TN103I086047Medicare PIN