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General NPI Number Information
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NPI Number | 1467915587
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Entity Type | Individual
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Provider Name | SAMUEL ALEXANDER KOCIOLA
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Gender | Male
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 500 MEDICAL ARTS BLDG STE 540
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City | KITTANNING
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State | PA
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Zip | 16201-7137
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Country | US
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Telephone | 724-543-4942
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 N MEADOWS DR
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City | GROVE CITY
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State | OH
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Zip | 43123-2546
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Country | US
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Telephone | 614-663-4550
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Fax | 614-663-4555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS023836
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License Number State | PA
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