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NPI Code Detail

MEDICARE: DR. CYRIL MAZANSKY M.D.

MEDICARE: DR. CYRIL MAZANSKY 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
12085R0202XDiagnostic Radiology Physician38412MA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2300040980OTHERMARR MEDICARE

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 : 1568421907
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CYRIL MAZANSKY M.D.
Provider Business Mailing Address
First Line : PO BOX 1849
Second Line :
City : LEWISTON
State : ME
Zip : 04241-1849
Country : US
Telephone Number : 207-784-2554
Fax Number : 207-777-5363
Provider Business Practice Location Address
First Line : 2100 DORCHESTER AVE
Second Line :
City : BOSTON
State : MA
Zip : 02124-5615
Country : US
Telephone Number : 617-296-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 05/30/2012

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