Provider Demographics
NPI:1609840370
Name:KAZLOW, GARY ALAN (MD,FCCP)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:KAZLOW
Suffix:
Gender:M
Credentials:MD,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 CATCHFLY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2345
Mailing Address - Country:US
Mailing Address - Phone:410-715-0634
Mailing Address - Fax:
Practice Address - Street 1:10805 HICKORY RIDGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3626
Practice Address - Country:US
Practice Address - Phone:410-715-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE78410Medicare UPIN
MD374LMedicare PIN