MEDICARE: CONSTANTINE KOSMAS 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	207RC0000X	Cardiovascular Disease Physician	198677	NY

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	:	1407855075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANTINE KOSMAS M.D.

Provider Business Mailing Address
First Line	:	3074 31ST ST
Second Line	:	5TH FLOOR
City	:	ASTORIA
State	:	NY
Zip	:	11102-1857
Country	:	US
Telephone Number	:	718-808-7700
Fax Number	:	718-808-7706

Provider Business Practice Location Address
First Line	:	30-16 30TH DRIVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102
Country	:	US
Telephone Number	:	718-545-2250
Fax Number	:	718-545-2252

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/13/2012

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