Provider Demographics
NPI:1356379689
Name:MAZZARELLA, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MAZZARELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 N 43RD AVE
Mailing Address - Street 2:5
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-8111
Mailing Address - Country:US
Mailing Address - Phone:623-915-1000
Mailing Address - Fax:623-934-0224
Practice Address - Street 1:7802 N 43RD AVE
Practice Address - Street 2:5
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-8111
Practice Address - Country:US
Practice Address - Phone:623-915-1000
Practice Address - Fax:623-934-0224
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ18157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ410887Medicaid
E59838Medicare UPIN