Healthcare Provider Details

I. General information

NPI: 1376287508
Provider Name (Legal Business Name): TEODOR KOUZOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19277 PLANTATION RD
REHOBOTH BEACH DE
19971-4411
US

IV. Provider business mailing address

18305 SEASHELL BLVD
LEWES DE
19958-6408
US

V. Phone/Fax

Practice location:
  • Phone: 302-604-9797
  • Fax:
Mailing address:
  • Phone: 920-883-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0028150
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: