MEDICARE: ANITA GENNY KO 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	207RP1001X	Pulmonary Disease Physician	MD418898	PA
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	MD418898	PA

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	:	1952358509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA GENNY KO MD

Provider Business Mailing Address
First Line	:	1601 CHERRY ST
Second Line	:	SUITE 11511
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1321
Country	:	US
Telephone Number	:	215-482-0699
Fax Number	:	215-482-0554

Provider Business Practice Location Address
First Line	:	10 SHURS LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2123
Country	:	US
Telephone Number	:	215-482-0699
Fax Number	:	215-482-0554

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/30/2016

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Directions to “ ANITA GENNY KO MD” Practice Location

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