Healthcare Provider Details

I. General information

NPI: 1699774695
Provider Name (Legal Business Name): GEORGE M KOSCO III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 OLD POST RD
HARRISBURG PA
17110-3671
US

IV. Provider business mailing address

2801 OLD POST RD
HARRISBURG PA
17110-3671
US

V. Phone/Fax

Practice location:
  • Phone: 717-651-1515
  • Fax: 717-651-1512
Mailing address:
  • Phone: 717-651-1515
  • Fax: 717-651-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS006971L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS006971L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: