Provider Demographics
NPI:1295713592
Name:MAZZYE, MARK A SR (RPA C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:MAZZYE
Suffix:SR
Gender:M
Credentials:RPA C
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Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:STE 500
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1885
Mailing Address - Country:US
Mailing Address - Phone:315-471-8388
Mailing Address - Fax:315-471-8019
Practice Address - Street 1:5586 LEGIONNAIRE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-3504
Practice Address - Country:US
Practice Address - Phone:315-699-2837
Practice Address - Fax:315-752-9506
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2017-07-31
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Provider Licenses
StateLicense IDTaxonomies
NY006833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02383113Medicaid
S99441Medicare UPIN