Basic Information
| Provider Information | |||||||||
| NPI: | 1992700371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOH | ||||||||
| FirstName: | JEANMARIE | ||||||||
| MiddleName: | ATIENZA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1086 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159054305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145341555 | ||||||||
| FaxNumber: | 8145358720 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 WILLIAM PENN AVE | ||||||||
| Address2: | |||||||||
| City: | CONEMAUGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159091609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143221519 | ||||||||
| FaxNumber: | 8143221454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 05/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD052897L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001469440 | 05 | PA | MEDICAID |