Healthcare Provider Details

I. General information

NPI: 1477202943
Provider Name (Legal Business Name): PHILLIP PAUL COZZI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

210 E UNIVERSITY PKWY
BALTIMORE MD
21218-2828
US

V. Phone/Fax

Practice location:
  • Phone: 210-554-2000
  • Fax:
Mailing address:
  • Phone: 210-542-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberH0107070
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO210012958
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: