Individual
DR. JONATHAN KOCMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1315 EAST BLVD, SUITE 280, CHARLOTTE, NC 28203-5975
(704) 384-1866
(704) 384-1867
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1866
(704) 384-1867
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
200400368
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89136TP
—
NC
Enumeration date
09/13/2005
Last updated
10/25/2020
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