Provider Demographics
NPI:1699774695
Name:KOSCO, GEORGE M III (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:KOSCO
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3671
Mailing Address - Country:US
Mailing Address - Phone:717-651-1515
Mailing Address - Fax:717-651-1512
Practice Address - Street 1:2801 OLD POST RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3671
Practice Address - Country:US
Practice Address - Phone:717-651-1515
Practice Address - Fax:717-651-1512
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006971L207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000589805Medicare ID - Type UnspecifiedPROVIDER NUMBER
PAFA41753Medicare UPIN