Provider Demographics
NPI:1891832150
Name:KAZA, ADITYA K (MD)
Entity Type:Individual
Prefix:DR
First Name:ADITYA
Middle Name:K
Last Name:KAZA
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 1:300 LONGWOOD AVE BADER 273
Mailing Address - Street 2:DEPARTMENT OF CARDIAC SURGERY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-7932
Mailing Address - Fax:617-730-0214
Practice Address - Street 1:300 LONGWOOD AVE BADER 273
Practice Address - Street 2:DEPARTMENT OF CARDIAC SURGERY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-7932
Practice Address - Fax:617-730-0214
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41481208G00000X
UT6981309-1205208G00000X
MA257290208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6981309-1205OtherMEDICAL LICENSE