Provider Demographics
NPI:1841374469
Name:COSKLO, SANDRA (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:COSKLO
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:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-0517
Mailing Address - Country:US
Mailing Address - Phone:570-282-6485
Mailing Address - Fax:570-281-1256
Practice Address - Street 1:BOX 120 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLIFFORD
Practice Address - State:PA
Practice Address - Zip Code:18413
Practice Address - Country:US
Practice Address - Phone:570-222-5200
Practice Address - Fax:570-222-5201
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008778L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1534978Medicaid
002242OtherFIRST PRIORITY HEALTH
785666OtherBLUE SHIELD
G09363Medicare UPIN
002242OtherFIRST PRIORITY HEALTH