Provider Demographics
NPI:1003826793
Name:COZZA, MICHAEL R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:COZZA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1030 BEAVER HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-3128
Mailing Address - Country:US
Mailing Address - Phone:724-770-0410
Mailing Address - Fax:724-770-0414
Practice Address - Street 1:1030 BEAVER HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-3128
Practice Address - Country:US
Practice Address - Phone:724-770-0410
Practice Address - Fax:724-770-0414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD035940L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009759130001Medicaid
PA0009759130001Medicaid
PAB37000Medicare UPIN