Provider Demographics
NPI:1467442798
Name:COSAR, EDIZ F (MD)
Entity Type:Individual
Prefix:
First Name:EDIZ
Middle Name:F
Last Name:COSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:280 CHESTNUT STREET, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT STREET
Practice Address - Street 2:D1170
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1619
Practice Address - Country:US
Practice Address - Phone:413-794-4550
Practice Address - Fax:413-794-3195
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA222585207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2087294Medicaid
MAA3773601Medicare PIN
MAI18162Medicare UPIN