Provider Demographics
NPI:1376521096
Name:KOUZOVA, MARGARITA K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:K
Last Name:KOUZOVA
Suffix:
Gender:F
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:PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-8500
Mailing Address - Country:US
Mailing Address - Phone:800-528-3448
Mailing Address - Fax:864-322-0167
Practice Address - Street 1:2260 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4765
Practice Address - Country:US
Practice Address - Phone:800-528-3448
Practice Address - Fax:864-322-0167
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45085020207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34423700Medicaid
H91231Medicare UPIN
WIP00134406Medicare ID - Type UnspecifiedRAILROAD MEDICARE