MEDICARE: DOUGLAS J KOZA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	30069	MA

General Provider Information

NPI Number	:	1154398139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS J KOZA M.D.

Provider Business Mailing Address
First Line	:	88 E NEWTON ST
Second Line	:	DEPT RADIOLOGY
City	:	BOSTON
State	:	MA
Zip	:	02118-2658
Country	:	US
Telephone Number	:	617-638-6610
Fax Number	:	617-638-6616

Provider Business Practice Location Address
First Line	:	81 GROVE ST
Second Line	:
City	:	NORFOLK
State	:	MA
Zip	:	02056-1756
Country	:	US
Telephone Number	:	508-528-9547
Fax Number	:	508-528-9547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/08/2007

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