Provider Demographics
NPI:1043278617
Name:BAZZOLI, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BAZZOLI
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:L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-8080
Practice Address - Fax:740-383-8084
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039399B207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160017770OtherTRAVELERS MEDICARE
OH2873884400OtherBWC
311098079OtherTAXID E
311098079OtherTAX ID
OH000000118145OtherANTHEM
353077OtherSUBMITTER NO
OH0308161Medicaid
0700040OtherUHC
311098079060OtherCIGNA
646799OtherAETNA
OHH128310Medicare PIN
OH000000118145OtherANTHEM
0700040OtherUHC