Healthcare Provider Details

I. General information

NPI: 1912977935
Provider Name (Legal Business Name): DARIUSZ W KOZLOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HART ST BLDG A, 2ND FLR
NEW BRITAIN CT
06052-1743
US

IV. Provider business mailing address

40 HART STREET BLDG A
NEW BRITAIN CT
06052
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-2447
  • Fax: 860-826-5845
Mailing address:
  • Phone: 860-224-2447
  • Fax: 860-826-5845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number035047
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: