Provider Demographics
NPI:1063496008
Name:MAZZEI, BRIAN J (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:MAZZEI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-4705
Mailing Address - Country:US
Mailing Address - Phone:276-623-0333
Mailing Address - Fax:276-623-0213
Practice Address - Street 1:1231 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-4705
Practice Address - Country:US
Practice Address - Phone:276-623-0333
Practice Address - Fax:276-623-0213
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010300940213ES0103X
TN450213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4350350Medicaid
VA9300732Medicaid
1480758OtherUMWA
118872001OtherADMINISTAR FEDERAL
118872001OtherDME
VA280049OtherANTHEM
VA480000659Medicare PIN
118872001OtherADMINISTAR FEDERAL
VAU52230Medicare UPIN
VA280049OtherANTHEM