Provider Demographics
NPI:1144285149
Name:KOSOWICZ, AUGUSTA BLUNDON (PA-C)
Entity type:Individual
Prefix:MS
First Name:AUGUSTA
Middle Name:BLUNDON
Last Name:KOSOWICZ
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3415 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1334
Mailing Address - Country:US
Mailing Address - Phone:304-388-8380
Mailing Address - Fax:304-388-8395
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-388-8380
Practice Address - Fax:304-388-8388
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-12-23
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Provider Licenses
StateLicense IDTaxonomies
WV431363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV0619AMedicare PIN