MEDICARE: DR. MARIA MAZZOTTI DO

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
1	207Q00000X	Family Medicine Physician	OS008840L	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1689601288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA MAZZOTTI DO

Provider Business Mailing Address
First Line	:	3960 LANKENAU AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2827
Country	:	US
Telephone Number	:	215-829-0101
Fax Number	:	215-829-4349

Provider Business Practice Location Address
First Line	:	601 WALNUT ST
Second Line	:	SUITE 230E
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3323
Country	:	US
Telephone Number	:	215-334-4049
Fax Number	:	215-462-9722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/04/2012

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