Provider Demographics
NPI:1851484091
Name:MAZZARIOL, FERNANDA S (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDA
Middle Name:S
Last Name:MAZZARIOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1958
Mailing Address - Country:US
Mailing Address - Phone:914-779-0107
Mailing Address - Fax:
Practice Address - Street 1:122 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4706
Practice Address - Country:US
Practice Address - Phone:914-681-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2384212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology