Healthcare Provider Details

I. General information

NPI: 1184936742
Provider Name (Legal Business Name): ERIN ANDREA KOSCINSKI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2010
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 CAMPUS DR SUITE 200
ABINGDON VA
24210-9703
US

IV. Provider business mailing address

613 CAMPUS DR SUITE 200
ABINGDON VA
24210-9703
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-1186
  • Fax: 276-628-8507
Mailing address:
  • Phone: 276-628-1186
  • Fax: 276-628-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102203582
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2539
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: