Provider Demographics
NPI:1265429799
Name:MAZUR, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
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 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2694
Mailing Address - Country:US
Mailing Address - Phone:603-448-3121
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:10 ALICE PECK DAY DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2694
Practice Address - Country:US
Practice Address - Phone:603-448-3121
Practice Address - Fax:603-448-7462
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7729207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00006469OtherBCBS VT
NH58000OtherCIGNA
NH80001430Medicaid
VT0006469Medicaid
NH0105549Y0NH02OtherANTHEM ER
NH77P588OtherMVP
NH0105549Y0NH01OtherANTHEM ICC
NH0554900OtherANTHEM
NH$$$$$$$$$OtherCHAMPUS
NH77P588OtherMVP
NHD03364Medicare UPIN