MEDICARE: DR. THOMAS D KOHL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	MD066085L	PA
2	207Q00000X	Family Medicine Physician	MD066085L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265425706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS D KOHL MD

Provider Business Mailing Address
First Line	:	1701 CORNWALL RD
Second Line	:	STE 201
City	:	LEBANON
State	:	PA
Zip	:	17042-7480
Country	:	US
Telephone Number	:	717-675-1750
Fax Number	:	717-675-1787

Provider Business Practice Location Address
First Line	:	1701 CORNWALL RD
Second Line	:	STE 201
City	:	LEBANON
State	:	PA
Zip	:	17042-7480
Country	:	US
Telephone Number	:	717-675-1750
Fax Number	:	717-675-1787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	05/05/2021

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