Provider Demographics
NPI:1063074144
Name:KOSISKE, ANASTASIA CHERIE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:CHERIE ELIZABETH
Last Name:KOSISKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1900
Mailing Address - Fax:
Practice Address - Street 1:3511 GRAYSTONE PL SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8201
Practice Address - Country:US
Practice Address - Phone:828-732-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8623207Q00000X
NC2024-03068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAMD50277OtherSTATE OF IOWA