Provider Demographics
NPI:1588618730
Name:MAZZOTTA, FRANCESCO M (DO)
Entity Type:Individual
Prefix:
First Name:FRANCESCO
Middle Name:M
Last Name:MAZZOTTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:M
Other - Last Name:MAZZOTTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:109 MANTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5414
Mailing Address - Country:US
Mailing Address - Phone:215-416-5277
Mailing Address - Fax:
Practice Address - Street 1:33 W 3RD ST FL 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6523
Practice Address - Country:US
Practice Address - Phone:570-429-3501
Practice Address - Fax:570-429-3502
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009517L207Q00000X
PAOS009517-L207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG6588Medicare UPIN
PAMA00578Medicare ID - Type Unspecified