Provider Demographics
NPI:1073611430
Name:GAZZOLA, MARIA MARTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MARTA
Last Name:GAZZOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA MARTA
Other - Middle Name:DE OLIVEIRA
Other - Last Name:GAZZOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 VEAZEY DR
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-1668
Mailing Address - Country:US
Mailing Address - Phone:919-764-2611
Mailing Address - Fax:919-764-2181
Practice Address - Street 1:5720 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9089
Practice Address - Country:US
Practice Address - Phone:919-484-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-006012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135AEMedicaid