Provider Demographics
NPI:1710943790
Name:KOZLOW, ERIC JON (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JON
Last Name:KOZLOW
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 1:100 WESTWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4320
Mailing Address - Country:US
Mailing Address - Phone:336-883-1393
Mailing Address - Fax:336-883-7517
Practice Address - Street 1:120 DAVIS ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-629-5770
Practice Address - Fax:336-629-0130
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500975207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2217701BOtherMEDICARE ID
NC1235298589OtherGROUP NPI
NC50259OtherBCBS
NC8950259Medicaid
0202020OtherUNITED HEALTHCARE
NC2217701AOtherMEDICARE ID
NC2217701BOtherMEDICARE ID
G16134Medicare UPIN
NC2344388Medicare PIN
NC2217701AOtherMEDICARE ID
NC1235298589OtherGROUP NPI