Provider Demographics
NPI:1740260017
Name:KOHN, MARK I (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:I
Last Name:KOHN
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-7237
Mailing Address - Fax:215-707-9389
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-7237
Practice Address - Fax:215-707-9389
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032981E2085R0202X
NJ25MA081642002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD032981EOtherHEALTH PARTNERS
PA120683OtherPHCS
PA231955165OtherAETNA USHC
PA231955165OtherINTERGROUP SERVICES
NJP00398000OtherRRML
PA001114463OtherAMERICHOICE OF PA
PA0011144630004Medicaid
PA1031977OtherKEYSTONE MERCY
PA512306OtherHIGHMARK BLUE SHIELD
PAPA7584OtherHEALTHNET
PA0110323000OtherIBC KHPE
PA300025834OtherRAILROAD MEDICARE
NJ0127175Medicaid
PA001114463Medicaid
PAMD032981EOtherPA LICENSE
PA001114463OtherAMERICHOICE OF PA
PAPA7584OtherHEALTHNET
PA512306Medicare ID - Type Unspecified
PA001114463Medicaid