Provider Demographics
NPI:1881703759
Name:OATES, MARY KOSKO (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KOSKO
Last Name:OATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-739-3968
Mailing Address - Fax:805-739-3051
Practice Address - Street 1:116 SOUTH PALISADE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8905
Practice Address - Country:US
Practice Address - Phone:805-739-3968
Practice Address - Fax:805-739-3051
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72477208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB216449OtherMEDICARE ID
CAW21194AMedicare PIN
CAG72477Medicare PIN
CAWG72477CMedicare PIN