Provider Demographics
NPI:1811423452
Name:KOZIKOWSKI, JOSEPH GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GREGORY
Last Name:KOZIKOWSKI
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 1:245 FIRST ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1200
Mailing Address - Country:US
Mailing Address - Phone:617-444-8500
Mailing Address - Fax:
Practice Address - Street 1:245 FIRST ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1200
Practice Address - Country:US
Practice Address - Phone:617-444-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021521208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice