Healthcare Provider Details

I. General information

NPI: 1174589857
Provider Name (Legal Business Name): JAMES M KOBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 WEST RACE STREET
SOMERSET PA
15501
US

IV. Provider business mailing address

245 WEST RACE STREET
SOMERSET PA
15501
US

V. Phone/Fax

Practice location:
  • Phone: 814-443-4891
  • Fax: 814-443-4898
Mailing address:
  • Phone: 814-443-4891
  • Fax: 814-443-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD048058L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: