Provider Demographics
NPI:1194823690
Name:MAZZEI, ROBERT E (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MAZZEI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E ANTIETAM ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5794
Mailing Address - Country:US
Mailing Address - Phone:301-739-6144
Mailing Address - Fax:301-739-6163
Practice Address - Street 1:322 E ANTIETAM ST
Practice Address - Street 2:SUITE 106
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5794
Practice Address - Country:US
Practice Address - Phone:301-739-6144
Practice Address - Fax:301-739-6163
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH518012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265300100Medicaid
MDG08321Medicare UPIN
MDH547805TMedicare PIN
300080638Medicare PIN
MD265300100Medicaid
MDKN77815TMedicare PIN