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NPI Code Detail

MEDICARE: DR. ELIZABETH MARY MAZIARKA M.D.

MEDICARE: DR. ELIZABETH MARY MAZIARKA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician203049MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295765212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH MARY MAZIARKA M.D.
Provider Business Mailing Address
First Line : 637 WASHINGTON ST
Second Line :
City : DORCHESTER CENTER
State : MA
Zip : 02124-3510
Country : US
Telephone Number : 617-825-9660
Fax Number : 617-288-7898
Provider Business Practice Location Address
First Line : 637 WASHINGTON ST
Second Line :
City : DORCHESTER CENTER
State : MA
Zip : 02124-3510
Country : US
Telephone Number : 617-825-9660
Fax Number : 617-288-7898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 07/08/2007

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