MEDICARE: DR. MARC R KOSSMANN PSY.D.

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	103TC0700X	Clinical Psychologist	PS-007828-L	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
2	605819	OTHER		BLUE SHIELD

General Provider Information

NPI Number	:	1427001361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC R KOSSMANN PSY.D.

Provider Business Mailing Address
First Line	:	101 W EAGLE RD STE 147
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2244
Country	:	US
Telephone Number	:	610-506-3453
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W EAGLE RD STE 147
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2244
Country	:	US
Telephone Number	:	610-506-3453
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/17/2024

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