Provider Demographics
NPI:1275515322
Name:MAZZUCCO, JOHN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:MAZZUCCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 HOSPITAL DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6632
Mailing Address - Country:US
Mailing Address - Phone:413-540-5048
Mailing Address - Fax:413-540-5049
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6632
Practice Address - Country:US
Practice Address - Phone:413-540-5048
Practice Address - Fax:413-540-5049
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT031891208600000X
MA262537208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF-49068Medicare UPIN