Provider Demographics
NPI:1942387758
Name:MURAKOSHI, KOZO (MD)
Entity Type:Individual
Prefix:MR
First Name:KOZO
Middle Name:
Last Name:MURAKOSHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KOZO
Other - Middle Name:
Other - Last Name:MURAKOSHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8114 SANDPIPER CIRCLE
Mailing Address - Street 2:#100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-933-8101
Mailing Address - Fax:410-933-8106
Practice Address - Street 1:8114 SANDPIPER CIRCLE
Practice Address - Street 2:#100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-933-8101
Practice Address - Fax:410-933-8106
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015418208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD052821800Medicaid
MD052821800Medicaid