Provider Demographics
NPI:1578530051
Name:MAZUR, WOJCIECH (MD)
Entity Type:Individual
Prefix:
First Name:WOJCIECH
Middle Name:
Last Name:MAZUR
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 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-206-1120
Mailing Address - Fax:513-206-1122
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-206-1120
Practice Address - Fax:513-206-1122
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081420207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64053762Medicaid
060071267OtherRAILROAD MEDICARE
283871OtherAMERIGROUP
2847307OtherAETNA
000000252112OtherANTHEM
IN200408710Medicaid
OH2347839Medicaid
2503091OtherUNITED
8142001OtherHUMANA
8142001OtherHUMANA
IN200408710Medicaid
OH4082361Medicare PIN
060071267OtherRAILROAD MEDICARE
IN200408710Medicaid