Provider Demographics
NPI:1336121524
Name:MARZO, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MARZO
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 1:3435 MAIN ST
Mailing Address - Street 2:160 FARBER HALL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-2982
Mailing Address - Fax:716-829-3945
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:160 FARBER HALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-2982
Practice Address - Fax:716-829-3945
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164844174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE99762Medicare UPIN
NYG76011Medicare ID - Type UnspecifiedMEDICARE #