Basic Information
| Provider Information | |||||||||
| NPI: | 1750549655 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WILLIAM KOBER MD NORTHERN BERKSHIRE FAMILY PRACTICE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 STATE RD | ||||||||
| Address2: | |||||||||
| City: | NORTH ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012473027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136644088 | ||||||||
| FaxNumber: | 4136636405 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 STATE RD | ||||||||
| Address2: | |||||||||
| City: | NORTH ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012473027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136644088 | ||||||||
| FaxNumber: | 4136636405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2008 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | KOBER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4136644088 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 79105 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 079105 | 01 | TUFTS | OTHER | 3121500 | 05 | MA | MEDICAID | J14465 | 01 | BCBS MA | OTHER |