Provider Demographics
NPI:1811951551
Name:MARZ, PAUL L (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:MARZ
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 1:237 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664
Mailing Address - Country:US
Mailing Address - Phone:508-394-2116
Mailing Address - Fax:
Practice Address - Street 1:237 STATION AVE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664
Practice Address - Country:US
Practice Address - Phone:508-394-2116
Practice Address - Fax:508-760-1919
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3059201Medicaid
MAJ09504OtherBLUE CROSS BLUE SHIELD
MA3059201Medicaid