Provider Demographics
NPI:1922679398
Name:ALMASRY, MAZEN
Entity Type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:ALMASRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MAZEN
Other - Middle Name:MOHAMED MAHER
Other - Last Name:ALMASRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:749 UNIVERSITY ROW, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:749 UNIVERSITY ROW, SUITE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705
Practice Address - Country:US
Practice Address - Phone:216-304-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8830-851390200000X
WI8140120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program