Provider Demographics
NPI:1679531297
Name:KOZLOVSKY, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KOZLOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LYNNWAY
Mailing Address - Street 2:APT# 702
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3498
Mailing Address - Country:US
Mailing Address - Phone:978-354-4010
Mailing Address - Fax:
Practice Address - Street 1:81 HIGHLAND AVENUE
Practice Address - Street 2:NORTH SHORE MEDICAL CENTER
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01907
Practice Address - Country:US
Practice Address - Phone:978-354-4010
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1557632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry