Provider Demographics
NPI:1750521464
Name:MAZZURCO, LAUREN WASSON (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:WASSON
Last Name:MAZZURCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7040
Mailing Address - Fax:757-446-7049
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7040
Practice Address - Fax:757-446-7049
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102203859207RG0300X
MI5101017884207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750521464OtherVIRGINIA HEALTH NETWORK
VA1750521464OtherAETNA
VA433416OtherANTHEM
VAPAROtherMULTIPLAN
VA1750521464OtherUNITED HEALTHCARE
VA1750521464Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL
VA1750521464OtherCOVENTRY NETWORK
VA1750521464OtherSEDGWICK CMS
VA-022OtherTRICARE/CHAMPUS
VA1750521464OtherVIRGINIA PREMIER HEALTH PLAN
VA1750521464OtherCIGNA
VA1750521464OtherOPTIMA HEALTH
NC1750521464Medicaid
VAVVF700AMedicare PIN
VAP01488573Medicare PIN