Provider Demographics
NPI:1912905209
Name:MAZZA, JOSEPH P (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:MAZZA
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 1:6 BLACKSTONE VALLEY PL STE 105
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1112
Mailing Address - Country:US
Mailing Address - Phone:401-762-3838
Mailing Address - Fax:401-762-8252
Practice Address - Street 1:6 BLACKSTONE VALLEY PL STE 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1112
Practice Address - Country:US
Practice Address - Phone:401-762-3838
Practice Address - Fax:401-762-8252
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07909207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001415Medicaid
RI069080039Medicare PIN
RI069006280Medicare PIN
RI7001415Medicaid
RI060064505Medicare PIN
RI007060848Medicare PIN