MEDICARE: DR. MELINDA ANN KOHR PH.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	PSY636	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113678753	OTHER	HI	TRICARE
2	113678753	OTHER	HI	ALOHA CARE
3	113678753	OTHER	HI	HMAA
4	113678753	OTHER	HI	KAISER ADDED CHOICE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	00A0217719	OTHER	HI	HMSA QUEST
7	217075	OTHER	HI	HMA
8	A217719	OTHER	HI	HMSA
9	PSY636	OTHER	HI	QUEENS MEDICAL

General Provider Information

NPI Number	:	1750364766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELINDA ANN KOHR PH.D.

Provider Business Mailing Address
First Line	:	33316 HEAVENLY WAY STE 203
Second Line	:
City	:	OCEAN VIEW
State	:	DE
Zip	:	19970-3473
Country	:	US
Telephone Number	:	302-567-1695
Fax Number	:	302-616-3934

Provider Business Practice Location Address
First Line	:	32828 REBA RD STE A
Second Line	:
City	:	MILLVILLE
State	:	DE
Zip	:	19967-6909
Country	:	US
Telephone Number	:	302-567-1695
Fax Number	:	302-616-3934

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	05/08/2019

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