Provider Demographics
NPI:1689675027
Name:KAZNOSKI, DEREK D (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:D
Last Name:KAZNOSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 SHEPHERDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-0500
Mailing Address - Country:US
Mailing Address - Phone:304-264-9332
Mailing Address - Fax:
Practice Address - Street 1:1178 SHEPHERDSTOWN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-0500
Practice Address - Country:US
Practice Address - Phone:304-264-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23323207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology