Healthcare Provider Details

I. General information

NPI: 1164565115
Provider Name (Legal Business Name): DAVID E. KOZONO M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BWH RADIATION ONCOLOGY ASB1-L2
BOSTON MA
02115-6110
US

IV. Provider business mailing address

110 CYPRESS ST UNIT PH1
BROOKLINE MA
02445-6027
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3591
  • Fax:
Mailing address:
  • Phone: 617-232-2049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number230766
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: