Provider Demographics
NPI:1306809918
Name:MAZZIOTTI, MARK V (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:V
Last Name:MAZZIOTTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 GREENWAY PLAZA
Mailing Address - Street 2:SUITE 910
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:CC650 00
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-822-3135
Practice Address - Fax:832-825-3141
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2025-08-29
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Provider Licenses
StateLicense IDTaxonomies
TXL24532086S0120X
MTMED-PHYS-LIC-1004622086S0120X
OK305402086S0120X
AZ754932086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112545202Medicaid
OK200122410AMedicaid
TX154947902Medicaid
TX8L0767Medicare PIN
G08927Medicare UPIN
TX154947902Medicaid