Provider Demographics
NPI:1801024302
Name:KOZIOL-DUBE, KASIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KASIA
Middle Name:
Last Name:KOZIOL-DUBE
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 1:1062 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-6012
Mailing Address - Country:US
Mailing Address - Phone:203-294-6328
Mailing Address - Fax:203-294-6346
Practice Address - Street 1:4 FARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2573
Practice Address - Country:US
Practice Address - Phone:860-284-5200
Practice Address - Fax:860-284-5333
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051141208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics