MEDICARE: DR. KENNETH O CHO 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	207X00000X	Orthopaedic Surgery Physician	TD061101	ME
2	207X00000X	Orthopaedic Surgery Physician	0101017689	VA
3	207X00000X	Orthopaedic Surgery Physician	2783	DC

General Provider Information

NPI Number	:	1609969948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH O CHO M.D.

Provider Business Mailing Address
First Line	:	111 FRANKLIN HEALTH CMNS
Second Line	:
City	:	FARMINGTON
State	:	ME
Zip	:	04938-6144
Country	:	US
Telephone Number	:	207-779-2628
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 MT BLUE CIR
Second Line	:
City	:	FARMINGTON
State	:	ME
Zip	:	04938-6239
Country	:	US
Telephone Number	:	207-778-9001
Fax Number	:

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	07/08/2007

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