Healthcare Provider Details

I. General information

NPI: 1376717454
Provider Name (Legal Business Name): DENNIS T. COZZENS, MD., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 OSAGE ST SUITE 404
ALEXANDRIA VA
22302-2607
US

IV. Provider business mailing address

1707 OSAGE ST SUITE 404
ALEXANDRIA VA
22302-2607
US

V. Phone/Fax

Practice location:
  • Phone: 703-824-8248
  • Fax: 703-824-8212
Mailing address:
  • Phone: 703-824-8248
  • Fax: 703-824-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0101-038031
License Number StateVA

VIII. Authorized Official

Name: DR. DENNIS THOMAS COZZENS
Title or Position: PRESIDENT
Credential: MD
Phone: 703-824-8248