Provider Demographics
NPI:1538334594
Name:DER SIMONIAN, KOHAR (MD)
Entity type:Individual
Prefix:DR
First Name:KOHAR
Middle Name:
Last Name:DER SIMONIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KOHAR
Other - Middle Name:
Other - Last Name:DERSIMONIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5 BUCKNAM RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1392
Mailing Address - Country:US
Mailing Address - Phone:207-781-1500
Mailing Address - Fax:207-781-1507
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-781-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400232880Medicare PIN
MEE400232883Medicare PIN