Provider Demographics
NPI:1952713489
Name:KOSMACH, STERLING NICOLE (DO)
Entity type:Individual
Prefix:
First Name:STERLING
Middle Name:NICOLE
Last Name:KOSMACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:877-647-0202
Practice Address - Street 1:1625 MEDICAL CENTER PT STE 190
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8721
Practice Address - Country:US
Practice Address - Phone:719-345-1047
Practice Address - Fax:877-647-0202
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0068645390200000X, 207K00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN