Mary Koethe, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2019-00748 Issued in NC

Practice address

508 Fulton St
Durham, NC 27705-3875

Phone

(919) 416-8092

NPI assigned

Apr 28, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1255786190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 FULTON ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053875",
            "telephone_number": "919-416-8092",
            "fax_number": "919-416-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 FULTON ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053875",
            "telephone_number": "919-416-8092"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Macnider Hl",
            "address_2": "Campus Box #7005",
            "address_purpose": "LOCATION",
            "city": "Chapel Hill",
            "state": "NC",
            "postal_code": "275990001",
            "country_code": "US",
            "telephone_number": "919-966-4468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOETHE",
        "first_name": "MARY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-28",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2019-00748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harold George Koenig, MD
• Mackenzie Caroline Koenig
• Brett Koermer
• Madeline Marie Koermer, LCSW
• Dana Marie Koerner, MSPT
• Elizabeth Frances Kofsky
• Tae Ho Koh
• Harajeshwar Kohli, M.D.
• Debra Kohlman-Trigoboff, NP
• Heidi Kohltfarber, DDS

• Internal Medicine Physician in Durham, NC
• Providers in Durham, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.