Provider Demographics
NPI:1912267386
Name:MAZOR, ANNA MARRISSA (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARRISSA
Last Name:MAZOR
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Gender:F
Credentials:DO
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Mailing Address - Street 1:1648 HUNTINGDON PIKE
Mailing Address - Street 2:MEDICAL STAFF OFFICE FIRST FLOOR
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8001
Mailing Address - Country:US
Mailing Address - Phone:215-938-3450
Mailing Address - Fax:215-938-3829
Practice Address - Street 1:45 2ND STREET PIKE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3829
Practice Address - Country:US
Practice Address - Phone:633-345-6215
Practice Address - Fax:215-396-3456
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2019-08-23
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Provider Licenses
StateLicense IDTaxonomies
PAOT014677208600000X
PAOS018407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOT014677Medicaid