Provider Demographics
NPI:1841282076
Name:KOSHY, N. MATHEW (MD)
Entity type:Individual
Prefix:DR
First Name:N.
Middle Name:MATHEW
Last Name:KOSHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5741 BEE RIDGE RD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5064
Mailing Address - Country:US
Mailing Address - Phone:941-377-8266
Mailing Address - Fax:941-378-9545
Practice Address - Street 1:5741 BEE RIDGE RD
Practice Address - Street 2:SUITE 490
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5064
Practice Address - Country:US
Practice Address - Phone:941-377-8266
Practice Address - Fax:941-378-9545
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33862207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030402435OtherTAX ID
FL79547OtherBCBS
FL066839700Medicaid
FL060068717OtherMEDICARE RR
FL066839700Medicaid
FL060068717OtherMEDICARE RR