Provider Demographics
NPI:1528053279
Name:KOSSEY, MICHELE A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:A
Last Name:KOSSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1114
Mailing Address - Country:US
Mailing Address - Phone:610-284-8409
Mailing Address - Fax:
Practice Address - Street 1:501 N LANSDOWNE AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-284-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065390L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA819175OtherFIRST PRIORITY HEALTH
PA101266154Medicaid
PA091700Medicare ID - Type Unspecified
PA101266154Medicaid