Provider Demographics
NPI:1447483862
Name:COBURN, KENNETH DOYLE (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:DOYLE
Last Name:COBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HONEYMAN RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3820
Mailing Address - Country:US
Mailing Address - Phone:908-432-1102
Mailing Address - Fax:
Practice Address - Street 1:875 N EASTON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-1068
Practice Address - Country:US
Practice Address - Phone:267-880-1733
Practice Address - Fax:267-880-1739
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166778207R00000X
PAMD-064027-L2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine