Provider Demographics
NPI:1699775486
Name:KOZEL, RANDY B (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:B
Last Name:KOZEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:112 CLOCK TOWER SQUARE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1365
Practice Address - Country:US
Practice Address - Phone:401-683-9002
Practice Address - Fax:401-293-0330
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2013-03-19
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Provider Licenses
StateLicense IDTaxonomies
RIMD077022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1208OtherNEIGHBORHOOD HEALTH PLAN
RI0000026648OtherBLUE SHIELD
007702OtherTUFTS HEALTH PLAN
3396039OtherAETNA US HEALTHCARE
AA92335OtherHARVARD PILGRIM
9227027OtherCIGNA HEALTHCARE
P00130048OtherRAILROAD MEDICARE
RIRK51170Medicaid
9227027OtherCIGNA HEALTHCARE
RIE90361Medicare UPIN