Provider Demographics
NPI:1205890035
Name:CUOZZO, DANIEL W (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:CUOZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:802-909-2053
Mailing Address - Fax:
Practice Address - Street 1:71 US ROUTE 1 STE J
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7168
Practice Address - Country:US
Practice Address - Phone:077-705-6212
Practice Address - Fax:207-203-4875
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0009898207N00000X
NY202324207N00000X
MEDO3222207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01658497Medicaid
NYG28337Medicare UPIN
NYBB6510Medicare ID - Type UnspecifiedUPSTATE