MEDICARE: RANDY B KOZEL MD

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	2084N0400X	Neurology Physician	MD07702	RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00130048	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1208	OTHER	RI	NEIGHBORHOOD HEALTH PLAN
2	0000026648	OTHER	RI	BLUE SHIELD
3	007702	OTHER		TUFTS HEALTH PLAN
4	3396039	OTHER		AETNA US HEALTHCARE
5	AA92335	OTHER		HARVARD PILGRIM
6	9227027	OTHER		CIGNA HEALTHCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699775486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY B KOZEL MD

Provider Business Mailing Address
First Line	:	200 MILL RD
Second Line	:	SUITE 180
City	:	FAIRHAVEN
State	:	MA
Zip	:	02719-5252
Country	:	US
Telephone Number	:	508-973-2000
Fax Number	:	508-973-2001

Provider Business Practice Location Address
First Line	:	112 CLOCK TOWER SQUARE
Second Line	:
City	:	PORTSMOUTH
State	:	RI
Zip	:	02871-1365
Country	:	US
Telephone Number	:	401-683-9002
Fax Number	:	401-293-0330

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/19/2013

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