Provider Demographics
NPI:1508829995
Name:KOZLOWSKI, FREDERICK HAROLD (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:HAROLD
Last Name:KOZLOWSKI
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 1:190 CAMPUS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-662-6135
Mailing Address - Fax:540-662-5845
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-662-6135
Practice Address - Fax:540-662-5845
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00875693OtherWV BLUE SHIELD GROUP
43938OtherSENTARA PROFESSIONAL
2119639OtherMAMSI PROFESSIONAL
WV0080509000Medicaid
000961320OtherWV BLUE SHIELD
222408OtherANTHEM PROFESSIONAL
WV3810003817OtherWV MEDICAID GROUP
08349100000OtherQUAL CHOICE PROFESSIONAL
VA005809436Medicaid
C00085OtherVA MEDICARE B GROUP
WV0080509000Medicaid
2119639OtherMAMSI PROFESSIONAL