Healthcare Provider Details

I. General information

NPI: 1568825602
Provider Name (Legal Business Name): ZACHARY KOZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 10 CRC RM 2W-5940,
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

8600 OLD GEORGETOWN RD FL 1
BETHESDA MD
20814-1497
US

V. Phone/Fax

Practice location:
  • Phone: 740-359-8663
  • Fax:
Mailing address:
  • Phone: 301-896-2574
  • Fax: 301-896-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number81919
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD-0091299
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD210002622
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: