MEDICARE: ROBERT KOORN MD

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	207L00000X	Anesthesiology Physician	200917-1	NY
2	207L00000X	Anesthesiology Physician	044260	CT
3	207L00000X	Anesthesiology Physician	5888390-1205	UT

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	:	1790781615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT KOORN MD

Provider Business Mailing Address
First Line	:	10 OLD REDDING RD
Second Line	:
City	:	REDDING
State	:	CT
Zip	:	06896-2201
Country	:	US
Telephone Number	:	203-224-3081
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 OLD REDDING RD
Second Line	:
City	:	REDDING
State	:	CT
Zip	:	06896-2201
Country	:	US
Telephone Number	:	203-224-3081
Fax Number	:

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/20/2009

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Directions to “ ROBERT KOORN MD” Practice Location

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