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NPI Code Detail

MEDICARE: DR. LOUIS MAZZELLA MD

MEDICARE:  DR. LOUIS  MAZZELLA  MD
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 Physician049824CT
22083P0011XUndersea and Hyperbaric Medicine (Preventive Medicine) PhysicianME110316FL
3390200000XStudent in an Organized Health Care Education/Training Program
4208D00000XGeneral Practice PhysicianME110316FL

General Provider Information

NPI Number : 1508029323
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOUIS MAZZELLA MD
Provider Business Mailing Address
First Line : 7 DEEPWOOD LN
Second Line : COTTAGE
City : WESTPORT
State : CT
Zip : 06880-1317
Country : US
Telephone Number : 404-805-2290
Fax Number :
Provider Business Practice Location Address
First Line : 246 49TH AVE N
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33703-3926
Country : US
Telephone Number : 904-518-7127
Fax Number : 727-205-4918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2008
Last Update Date : 12/02/2022

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Directions to “ DR. LOUIS MAZZELLA MD” Practice Location

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