Provider Demographics
NPI:1720280100
Name:KOZAUER AND KOZAUER PA
Entity Type:Organization
Organization Name:KOZAUER AND KOZAUER PA
Other - Org Name:POPLAR HILL MENTAL HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-822-6175
Mailing Address - Street 1:14225 POPLAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:DARNESTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3562
Mailing Address - Country:US
Mailing Address - Phone:240-683-5730
Mailing Address - Fax:
Practice Address - Street 1:110 N WASHINGTON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2223
Practice Address - Country:US
Practice Address - Phone:301-208-0930
Practice Address - Fax:301-424-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02708Medicare PIN