Provider Demographics
NPI:1508029323
Name:MAZZELLA, LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:MAZZELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIZ
Other - Middle Name:
Other - Last Name:MAZZELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7 DEEPWOOD LN
Mailing Address - Street 2:COTTAGE
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1317
Mailing Address - Country:US
Mailing Address - Phone:404-805-2290
Mailing Address - Fax:
Practice Address - Street 1:246 49TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3926
Practice Address - Country:US
Practice Address - Phone:904-518-7127
Practice Address - Fax:727-205-4918
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049824207Q00000X
FLME1103162083P0011X, 208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty