Provider Demographics
NPI:1265405294
Name:MAZZOCHETTI, RALPH DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DAVID
Last Name:MAZZOCHETTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:232 SUNBURY ST
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1346
Mailing Address - Country:US
Mailing Address - Phone:570-544-4590
Mailing Address - Fax:570-544-9686
Practice Address - Street 1:232 SUNBURY ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1346
Practice Address - Country:US
Practice Address - Phone:570-544-4590
Practice Address - Fax:570-544-9686
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005877L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001133039Medicaid
PAB41846Medicare UPIN
PA439088JPUMedicare ID - Type Unspecified