Provider Demographics
NPI:1952358509
Name:KO, ANITA GENNY (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:GENNY
Last Name:KO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1321
Mailing Address - Country:US
Mailing Address - Phone:215-482-0699
Mailing Address - Fax:215-482-0554
Practice Address - Street 1:10 SHURS LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-2123
Practice Address - Country:US
Practice Address - Phone:215-482-0699
Practice Address - Fax:215-482-0554
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD418898207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101269058Medicaid
PA091972Medicare PIN
PA101269058Medicaid