Healthcare Provider Details

I. General information

NPI: 1225094212
Provider Name (Legal Business Name): INGRID FOLLWEILER KOHUT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ 2ND FLOOR
PHILADELPHIA PA
19106-3500
US

IV. Provider business mailing address

230 W WASHINGTON SQ 2ND FLOOR
PHILADELPHIA PA
19106-3500
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-6088
  • Fax: 215-829-6104
Mailing address:
  • Phone: 215-829-6088
  • Fax: 215-829-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberOSO12318
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberOS012318
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: