Provider Demographics
NPI:1881664886
Name:MAZUR, ERIC M (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:MAZUR
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 1:280 NEWTOWN TPKE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-1320
Mailing Address - Country:US
Mailing Address - Phone:203-952-5929
Mailing Address - Fax:
Practice Address - Street 1:24 STEVENS ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3852
Practice Address - Country:US
Practice Address - Phone:203-852-2368
Practice Address - Fax:203-855-3589
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021096207RH0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOV5808OtherHEALTHNET
CT2543585OtherAETNA PROVIDER NUMBER
CT010021096CT01OtherANTHEM B/C
CT213321OtherUHC
CTZS925OtherOXFORD
DE001210963Medicaid
CT6893765-007OtherCITNA
CT210960OtherCONNECTICARE
CT6893765-007OtherCITNA
CT213321OtherUHC