Most Relevant Information
Provider Data
| NPI Number: | 1003342775 |
| Provider Name: | MERRICK DOUGLAS KOZAK M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: | 0116030312 |
Most Important Dates
| Enumeration Date: | 05/02/2017 |
| Last Updated: | 09/02/2021 |
Provider Practice Location
1221 LEE ST
CHARLOTTESVILLE
VA
229085051
Practice Location Phone/Fax
| Phone: | 4349245115 |
| Fax: | 4342444504 |
Provider Mailing Location
PO BOX 9007
CHARLOTTESVILLE
VA
229069007
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |