Provider Demographics
NPI:1275579864
Name:KOZAKIEWICZ, RICHARD T (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:KOZAKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3707
Mailing Address - Country:US
Mailing Address - Phone:724-836-7590
Mailing Address - Fax:724-836-7570
Practice Address - Street 1:120 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3707
Practice Address - Country:US
Practice Address - Phone:724-836-7590
Practice Address - Fax:724-836-7570
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060641L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01643678Medicaid
PA01643678Medicaid
PAKO901219Medicare ID - Type Unspecified