Healthcare Provider Details

I. General information

NPI: 1912031295
Provider Name (Legal Business Name): MICHAEL PHILIP KOSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST DEPT PEDIATRICS, DIV PEDI INFECTIOUS DISEASES
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY STREET DEPT OF PEDIATRICS, DIVISION OF PEDI INF. DISEASES
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8360
  • Fax: 401-444-5650
Mailing address:
  • Phone: 401-444-8360
  • Fax: 401-444-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12655
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD12655
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: