Healthcare Provider Details

I. General information

NPI: 1376285981
Provider Name (Legal Business Name): GEORGE VIVEK KOSHY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6812
  • Fax: 570-271-6507
Mailing address:
  • Phone: 570-271-6812
  • Fax: 570-271-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS024690
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: