Provider Demographics
NPI:1689691164
Name:KOZLOSKI, KARA (DO)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KOZLOSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-375-3911
Mailing Address - Fax:814-375-4424
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-3911
Practice Address - Fax:814-375-4424
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008945-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001698200Medicaid
PA001698200Medicaid
PA898426Medicare ID - Type Unspecified