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General NPI Number Information
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NPI Number | 1992700371
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Entity Type | Individual
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Provider Name | JEANMARIE ATIENZA KOH MD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 1940 WILLIAM PENN AVE
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City | CONEMAUGH
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State | PA
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Zip | 15909-1609
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Country | US
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Telephone | 814-322-1519
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Fax | 814-322-1454
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Provider Business Mailing Address
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Address Line | 1086 FRANKLIN ST
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4305
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Country | US
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Telephone | 814-534-1555
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Fax | 814-535-8720
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD052897L
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License Number State | PA
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