Provider Demographics
NPI:1578674248
Name:MAZALEWSKI, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:MAZALEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-2400
Mailing Address - Country:US
Mailing Address - Phone:321-434-4600
Mailing Address - Fax:321-259-0635
Practice Address - Street 1:8745 N WICKHAM RD
Practice Address - Street 2:VIERA HOSPITAL/RADIOLOGY DEPT
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-5997
Practice Address - Country:US
Practice Address - Phone:321-434-7313
Practice Address - Fax:321-434-7238
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL623132085R0202X
FLME623132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01388477OtherFL HFMG RR MEDICARE
FLP00377061OtherRAILROAD MEDICARE
FL265388500Medicaid
FLE8353SOtherFL HFMG MEDICARE