Provider Demographics
NPI:1336215623
Name:COZZOLINO, ANTHONY D JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:D
Last Name:COZZOLINO
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 OLENTANGY RIVER RD STE 10
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3119
Mailing Address - Country:US
Mailing Address - Phone:614-291-5555
Mailing Address - Fax:614-291-7720
Practice Address - Street 1:1275 OLENTANGY RIVER RD STE 10
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3119
Practice Address - Country:US
Practice Address - Phone:614-291-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003394213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000351734OtherANTHEM PIN
OH311253312-00OtherWORKERS COMP, RICK#097710
OH000000351734OtherANTHEM PIN
U56911Medicare UPIN
OHH507860Medicare PIN