Provider Demographics
NPI:1265425706
Name:KOHL, THOMAS D (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:KOHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1701 CORNWALL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7480
Mailing Address - Country:US
Mailing Address - Phone:717-675-1750
Mailing Address - Fax:717-675-1787
Practice Address - Street 1:1701 CORNWALL RD
Practice Address - Street 2:STE 201
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7480
Practice Address - Country:US
Practice Address - Phone:717-675-1750
Practice Address - Fax:717-675-1787
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD066085L207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001967961Medicaid
PA001967961Medicaid
H69120Medicare UPIN