Healthcare Provider Details

I. General information

NPI: 1205102852
Provider Name (Legal Business Name): VIKTORIA KOSKENOJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS STREET
BOSTON MA
02115
US

IV. Provider business mailing address

1025 W WASHINGTON ST STE A
MARQUETTE MI
49855-4031
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8070
  • Fax:
Mailing address:
  • Phone: 906-239-5050
  • Fax: 906-239-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number251512
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301109033
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: