Provider Demographics
NPI:1376717454
Name:DENNIS T. COZZENS, MD., LTD
Entity Type:Organization
Organization Name:DENNIS T. COZZENS, MD., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COZZENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-824-8248
Mailing Address - Street 1:1707 OSAGE ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2607
Mailing Address - Country:US
Mailing Address - Phone:703-824-8248
Mailing Address - Fax:703-824-8212
Practice Address - Street 1:1707 OSAGE ST
Practice Address - Street 2:SUITE 404
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2607
Practice Address - Country:US
Practice Address - Phone:703-824-8248
Practice Address - Fax:703-824-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-038031102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110806OtherKAISER
VA224524OtherANTHEM
VA063693OtherVALUE OPTIONS
VA224525OtherANTHEM