Provider Demographics
NPI:1366418444
Name:KOZINN, WESLEY P (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:P
Last Name:KOZINN
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 1:2061 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3953
Mailing Address - Country:US
Mailing Address - Phone:610-253-7818
Mailing Address - Fax:610-253-1764
Practice Address - Street 1:2061 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3953
Practice Address - Country:US
Practice Address - Phone:610-253-7818
Practice Address - Fax:610-253-1764
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020649E207RI0200X
NJMA043384207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW20008785Medicaid
PAP2626165OtherOXFORD HEALTH PLAN
PAPA3654OtherMULTI PLAN
PA03050500OtherKEYSTONE SENIOR BLUE
PA232167970OtherQUALCARE
PA469374OtherAETNA
PA000605770Medicaid
PA0041200000OtherKEYSTONE HEALTH PLAN EAST
NJ232167970OtherHORIZON BLUE SHIELD
PA232167970OtherBEECH STREET
PA03050500OtherCAPITOL BLUE CROSS
PA025420OtherAMERI HEALTH
PA025420OtherHIGHMARK BLUE SHIELD
PA0991406OtherKEYSTONE HEALTH PLAN CENT
PA232167970OtherPRIVATE HEALTHCARE SYSTEM
PA232167970OtherINTERGROUP
PA03050500OtherKEYSTONE SENIOR BLUE
PA232167970OtherINTERGROUP
PA03050500OtherCAPITOL BLUE CROSS
PAPA3654OtherMULTI PLAN
PA03050500OtherCAPITOL BLUE CROSS
PAB33527Medicare UPIN