MEDICARE: GREGORY T KOO 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	174400000X	Specialist	33614	KY
2	207Q00000X	Family Medicine Physician	33614	KY
3	208D00000X	General Practice Physician	33614	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205895943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY T KOO MD

Provider Business Mailing Address
First Line	:	PO BOX 39597
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-1249
Country	:	US
Telephone Number	:	859-288-2425
Fax Number	:	859-288-7510

Provider Business Practice Location Address
First Line	:	1401 HARRODSBURG RD STE B165
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-1726
Country	:	US
Telephone Number	:	859-288-2425
Fax Number	:	859-288-7510

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/15/2025

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