Provider Demographics
NPI:1477522571
Name:KOZA, MARYA A (MD)
Entity Type:Individual
Prefix:
First Name:MARYA
Middle Name:A
Last Name:KOZA
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 1:844 FRANKLIN ST.
Mailing Address - Street 2:#4
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093
Mailing Address - Country:US
Mailing Address - Phone:508-384-2500
Mailing Address - Fax:508-384-9410
Practice Address - Street 1:844 FRANKLIN ST.
Practice Address - Street 2:#4
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093
Practice Address - Country:US
Practice Address - Phone:508-384-2500
Practice Address - Fax:508-384-9410
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209530174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ26470OtherBCBS BLUE CROSS BLUE SHIELD
MA2014661Medicaid
MAA35771Medicare ID - Type Unspecified
MAH90143Medicare UPIN
MAJ26470OtherBCBS BLUE CROSS BLUE SHIELD