Provider Demographics
NPI:1487758348
Name:KOZYREVA, OLGA N (MD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:N
Last Name:KOZYREVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:736 CAMBRIGE STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-789-2903
Mailing Address - Fax:617-789-2064
Practice Address - Street 1:736 CAMBRIGE STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-2903
Practice Address - Fax:617-789-2064
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2019-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA230270207R00000X, 207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology