Individual
DR. MARC R KOSSMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
101 W EAGLE RD STE 147, HAVERTOWN, PA 19083-2244
(610) 506-3453
Mailing address
101 W EAGLE RD STE 147, HAVERTOWN, PA 19083-2244
(610) 506-3453
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS-007828-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1499690-41
—
PA
01
—
605819
BLUE SHIELD
—
Enumeration date
05/19/2006
Last updated
07/17/2024
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