Basic Information
| Provider Information | |||||||||
| NPI: | 1154398139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZA | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 E NEWTON ST | ||||||||
| Address2: | DEPT RADIOLOGY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176386610 | ||||||||
| FaxNumber: | 6176386616 | ||||||||
| Practice Location | |||||||||
| Address1: | 81 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020561756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085289547 | ||||||||
| FaxNumber: | 5085289547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 30069 | MA | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No ID Information.