MEDICARE: DR. REBECCA KOBOS M.D.

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	215264	NY

General Provider Information

NPI Number	:	1366599110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA KOBOS M.D.

Provider Business Mailing Address
First Line	:	1400 WASHINGTON AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12222-0100
Country	:	US
Telephone Number	:	518-442-5455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 WASHINGTON AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12222-0100
Country	:	US
Telephone Number	:	518-442-5455
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/02/2007

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