=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770522237
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT F COSHAREK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2006
-----------------------------------------------------
Last Update Date | 12/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4501 ADMIRAL PEARY HWY
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931-4332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-472-0506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 OAK LN
-----------------------------------------------------
City | BLAIRSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15717-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-459-0493
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD-037235-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------