MEDICARE: PETER J. KOBLENZER

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	207N00000X	Dermatology Physician	MD029332L	PA

General Provider Information

NPI Number	:	1619926896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER J. KOBLENZER

Provider Business Mailing Address
First Line	:	1812 DELANCEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6607
Country	:	US
Telephone Number	:	215-545-4674
Fax Number	:	215-545-4809

Provider Business Practice Location Address
First Line	:	1812 DELANCEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6607
Country	:	US
Telephone Number	:	215-545-4674
Fax Number	:	215-545-4809

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. PETER J KOBLENZER
Credential	:	MD
Telephone Number	:	215-545-4674

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	02/20/2008

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