MEDICARE: PHILLIP MICHAEL KEMP BOHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD480455	PA

General Provider Information

NPI Number	:	1073043030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP MICHAEL KEMP BOHAN MD

Provider Business Mailing Address
First Line	:	1800 LOMBARD STREET
Second Line	:	ROOM 206
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-0000
Country	:	US
Telephone Number	:	215-615-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 COOPER PLZ
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1461
Country	:	US
Telephone Number	:	856-342-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	01/21/2026

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