MEDICARE: DR. WILLIAM H KOBER 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	027036	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D400040801	OTHER	CT	MEDIARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	J14465	OTHER	MA	BLUE CROSS PROVIDER ID

General Provider Information

NPI Number	:	1396724134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM H KOBER M.D.

Provider Business Mailing Address
First Line	:	91 VOLUNTOWN RD
Second Line	:
City	:	PAWCATUCK
State	:	CT
Zip	:	06379-1366
Country	:	US
Telephone Number	:	860-599-5477
Fax Number	:	860-599-5676

Provider Business Practice Location Address
First Line	:	91 VOLUNTOWN RD
Second Line	:
City	:	PAWCATUCK
State	:	CT
Zip	:	06379-1366
Country	:	US
Telephone Number	:	860-599-5477
Fax Number	:	860-599-5676

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	08/07/2014

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Directions to “ DR. WILLIAM H KOBER M.D.” Practice Location

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