Provider Demographics
NPI:1356386817
Name:KOSENKO, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KOSENKO
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 1:350 E BAYFRONT PKWY
Mailing Address - Street 2:UNIT C
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-2410
Mailing Address - Country:US
Mailing Address - Phone:814-455-2279
Mailing Address - Fax:814-871-1786
Practice Address - Street 1:350 E BAYFRONT PKWY
Practice Address - Street 2:UNIT C
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-2410
Practice Address - Country:US
Practice Address - Phone:814-455-2279
Practice Address - Fax:814-871-1786
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033699E207RN0300X
OH35068000207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1356386817OtherRAILROAD MEDICARE
PA0010200620005Medicaid
PA1356386817OtherRAILROAD MEDICARE
B40351Medicare UPIN