MEDICARE: DR. ERICH L. KOSOWITZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	08100000901	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649341900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICH L. KOSOWITZ PH.D.

Provider Business Mailing Address
First Line	:	100 E SOUTH ST STE 5
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-5217
Country	:	US
Telephone Number	:	434-971-4747
Fax Number	:	434-293-4690

Provider Business Practice Location Address
First Line	:	100 E SOUTH ST STE 5
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-5217
Country	:	US
Telephone Number	:	434-971-4747
Fax Number	:	434-293-4690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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