Provider Demographics
NPI:1710125943
Name:NAYROUZ, MAZEN MICHAEL (MBCHB,MSC PEDS, DCH)
Entity Type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:MICHAEL
Last Name:NAYROUZ
Suffix:
Gender:M
Credentials:MBCHB,MSC PEDS, DCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF ROCHESTER MEDICAL
Mailing Address - Street 2:601 ELMWOOD AVENUE, BOX 651
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-276-3964
Mailing Address - Fax:585-461-3614
Practice Address - Street 1:UNIVERSITY OF ROCHESTER MEDICAL
Practice Address - Street 2:601 ELMWOOD AVENUE, BOX 651
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-276-3964
Practice Address - Fax:585-461-3614
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program