Provider Demographics
NPI:1154398139
Name:KOZA, DOUGLAS J (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:KOZA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:88 E NEWTON ST
Mailing Address - Street 2:DEPT RADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2658
Mailing Address - Country:US
Mailing Address - Phone:617-638-6610
Mailing Address - Fax:617-638-6616
Practice Address - Street 1:81 GROVE ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1756
Practice Address - Country:US
Practice Address - Phone:508-528-9547
Practice Address - Fax:508-528-9547
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA300692085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB97453Medicare UPIN
MAD28116Medicare ID - Type Unspecified