Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD062353-L | PA |
Y | 111NI0900X | Internist | MD062353-L | PA |
N | 207RC0200X | Critical Care Medicine | MD062353-L | PA |
NPI | 1003803263 |
---|---|
Provider Name | Paul Andrew Koberna |
First Address | State College, PA 16803-2292 |
Second Address | State College, PA 16803-2292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 31/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016455000003 | (05) | PA |
110237654 | RAILROAD MEDICARE (01) | PA |
21920 | GEISINGER (01) | PA |
50000805 | CAPITAL BC/BS (01) | PA |
952761 | HIGHMARK BS (01) | PA |
G09713 | (02) | PA |