Healthcare Provider Details

I. General information

NPI: 1801024302
Provider Name (Legal Business Name): KASIA KOZIOL-DUBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FARM SPRINGS RD
FARMINGTON CT
06032-2573
US

IV. Provider business mailing address

1062 BARNES RD
WALLINGFORD CT
06492-6012
US

V. Phone/Fax

Practice location:
  • Phone: 860-284-5200
  • Fax: 860-284-5333
Mailing address:
  • Phone: 203-294-6328
  • Fax: 203-294-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number051141
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: