Provider Demographics
NPI:1750549655
Name:WILLIAM KOBER MD NORTHERN BERKSHIRE FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:WILLIAM KOBER MD NORTHERN BERKSHIRE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-664-4088
Mailing Address - Street 1:820 STATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-3027
Mailing Address - Country:US
Mailing Address - Phone:413-664-4088
Mailing Address - Fax:413-663-6405
Practice Address - Street 1:820 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-3027
Practice Address - Country:US
Practice Address - Phone:413-664-4088
Practice Address - Fax:413-663-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
079105OtherTUFTS
MA3121500Medicaid
J14465OtherBCBS MA
MA3121500Medicaid