Provider Demographics
NPI:1104820927
Name:KOSAR, EROL M (MD)
Entity type:Individual
Prefix:
First Name:EROL
Middle Name:M
Last Name:KOSAR
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 1:2481 LOMITA BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5116
Mailing Address - Country:US
Mailing Address - Phone:310-257-0508
Mailing Address - Fax:310-325-8109
Practice Address - Street 1:2841 LOMITA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5116
Practice Address - Country:US
Practice Address - Phone:310-257-0508
Practice Address - Fax:310-325-8109
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2017-03-09
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
CAG75877207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G758770Medicaid
CAWG75877EOtherMEDICARE ID
CA00G758770Medicaid