=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730173063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES COZZARELLI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1057 S BROAD ST
-----------------------------------------------------
City | LANSDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19446-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-361-5834
-----------------------------------------------------
Fax | 215-412-4809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 822162
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19182-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-412-3191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD009298E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------