Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD15729 | RI |
NPI | 1003041336 |
---|---|
Provider Name | Mr. Thomas Adam Kosztowski |
First Address | Providence, RI 02905-4513 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2009 |
Last Update Date | 01/06/2017 |