Healthcare Provider Details

I. General information

NPI: 1841253762
Provider Name (Legal Business Name): ISAAC KOZIOL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 STONY POINT PKWY
RICHMOND VA
23235-1979
US

IV. Provider business mailing address

9105 STONY POINT PKWY
RICHMOND VA
23235-1979
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-1030
  • Fax: 804-288-3529
Mailing address:
  • Phone: 804-287-1030
  • Fax: 804-288-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101 019890
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: