MEDICARE: DR. SETH JEREMY KOSS 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	207Q00000X	Family Medicine Physician	MD066475L	PA

General Provider Information

NPI Number	:	1124169966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH JEREMY KOSS MD

Provider Business Mailing Address
First Line	:	108 FENNERTON RD
Second Line	:
City	:	PAOLI
State	:	PA
Zip	:	19301-1107
Country	:	US
Telephone Number	:	610-240-9299
Fax Number	:	610-687-0702

Provider Business Practice Location Address
First Line	:	950 W VALLEY RD STE 2301
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-1846
Country	:	US
Telephone Number	:	610-687-9334
Fax Number	:	610-687-0702

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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