Provider Demographics
NPI:1477661098
Name:BAZZOLI, ALLAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:SCOTT
Last Name:BAZZOLI
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:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:GAMBIER
Mailing Address - State:OH
Mailing Address - Zip Code:43022-0246
Mailing Address - Country:US
Mailing Address - Phone:740-392-6098
Mailing Address - Fax:740-392-1049
Practice Address - Street 1:300 W VINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-392-6098
Practice Address - Fax:740-392-1049
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045171246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0562181Medicaid
A15917Medicare UPIN
OH0562181Medicaid