Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD066085L | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD066085L | PA |
NPI | 1265425706 |
---|---|
Provider Name | Dr. Thomas D Kohl |
First Address | Lebanon, PA 17042-7480 |
Second Address | Lebanon, PA 17042-7480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 05/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001967961 | (05) | PA |
H69120 | (02) |