Provider Demographics
NPI:1649303108
Name:KOZMINSKI, MATTHEW PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PAUL
Last Name:KOZMINSKI
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 1:238 BEAR CREEK RD STE 510
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:PA
Mailing Address - Zip Code:16052-3204
Mailing Address - Country:US
Mailing Address - Phone:814-330-5061
Mailing Address - Fax:
Practice Address - Street 1:215 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1765
Practice Address - Country:US
Practice Address - Phone:724-749-4118
Practice Address - Fax:724-202-0394
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS203082084N0400X
PAOS013858208D00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS013858OtherLICENSE