Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD035940L | PA |
NPI | 1003826793 |
---|---|
Provider Name | Dr. Michael R. Cozza JR. |
First Address | Beaver, PA 15009-3128 |
Second Address | Beaver, PA 15009-3128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 24/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009759130001 | (05) | PA |
B37000 | (02) | PA |