Healthcare Provider Details

I. General information

NPI: 1275579864
Provider Name (Legal Business Name): RICHARD T KOZAKIEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 VILLAGE DR
GREENSBURG PA
15601-3707
US

IV. Provider business mailing address

120 VILLAGE DR
GREENSBURG PA
15601-3707
US

V. Phone/Fax

Practice location:
  • Phone: 724-836-7590
  • Fax: 724-836-7570
Mailing address:
  • Phone: 724-836-7590
  • Fax: 724-836-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD060641L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: