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Organization
CHARLES R. KOSSMAN, M.D., INC.
Active
Organization
CHARLES R. KOSSMAN, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES RICHARD KOSSMAN M.D. (PRESIDENT)
(619) 287-9910
Entity
Organization
Contact information
Practice address
5555 RESERVOIR DR, #306, SAN DIEGO, CA 92120-5134
(619) 287-9910
(619) 287-3526
Mailing address
5555 RESERVOIR DR, #306, SAN DIEGO, CA 92120-5134
(619) 287-9910
(619) 287-3526
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
G28857
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184799892
MEDICARE INDIVIDUAL NPI
CA
01
—
CN534Z
MEDICARE INDIVIDUAL PTAN
CA
01
—
CN538A
MEDICARE GROUP PTAN
CA
Enumeration date
12/09/2009
Last updated
12/22/2009
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