Provider Demographics
NPI:1689601288
Name:MAZZOTTI, MARIA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:MAZZOTTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3960 LANKENAU AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2827
Mailing Address - Country:US
Mailing Address - Phone:215-829-0101
Mailing Address - Fax:215-829-4349
Practice Address - Street 1:601 WALNUT ST
Practice Address - Street 2:SUITE 230E
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3323
Practice Address - Country:US
Practice Address - Phone:215-334-4049
Practice Address - Fax:215-462-9722
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS008840L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01651876Medicaid
PA01651876Medicaid
PAG54066Medicare UPIN