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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