Provider Demographics
NPI:1154552396
Name:LOZOWSKA, DOMINIKA (MD)
Entity type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:
Last Name:LOZOWSKA
Suffix:
Gender:F
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:PO BOX 746649
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6649
Mailing Address - Country:US
Mailing Address - Phone:904-376-4400
Mailing Address - Fax:904-391-5595
Practice Address - Street 1:841 PRUDENTIAL DR FL 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8329
Practice Address - Country:US
Practice Address - Phone:904-398-5404
Practice Address - Fax:904-391-5545
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1400762084N0008X, 2084N0600X, 2084N0400X
WV262852084N0008X, 2084N0400X, 2084N0600X
KYC20022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTBF4323200RWMedicaid