Provider Demographics
NPI:1154384386
Name:MARZZACCO, JOSEPH C (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:MARZZACCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1907
Mailing Address - Country:US
Mailing Address - Phone:570-282-6010
Mailing Address - Fax:
Practice Address - Street 1:30 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1907
Practice Address - Country:US
Practice Address - Phone:570-282-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-001633-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0502755Medicaid
PA0502755Medicaid
PAT29791Medicare UPIN