Provider Demographics
NPI:1861490872
Name:MAZA, RICHARD KAZDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KAZDIN
Last Name:MAZA
Suffix:
Gender:M
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:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:941-202-5342
Practice Address - Street 1:3253 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2043
Practice Address - Country:US
Practice Address - Phone:727-725-6170
Practice Address - Fax:727-799-3511
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065643700Medicaid
FL62280ZMedicare ID - Type Unspecified