Provider Demographics
NPI:1568499184
Name:KOZUCH, PATRICIA LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LORRAINE
Last Name:KOZUCH
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 1:132 S. 10TH ST.
Mailing Address - Street 2:480 MAIN BLDG
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-8900
Mailing Address - Fax:215-955-5245
Practice Address - Street 1:132 S. 10TH ST.
Practice Address - Street 2:480 MAIN BLDG
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-8900
Practice Address - Fax:215-955-5245
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36113799207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology