Individual
JOHN D KOETHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
230 W WASHINGTON SQ, SUITE 100, PHILADELPHIA, PA 19106-3500
(215) 829-8420
(215) 829-8418
Mailing address
230 W WASHINGTON SQ, SUITE 100, PHILADELPHIA, PA 19106-3500
(215) 829-8420
(215) 829-8418
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
033220E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000113314605
—
PA
01
—
0000407311
BLUE CROSS/BLUE SHIELD
—
Enumeration date
07/18/2005
Last updated
05/11/2010
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