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NPI Code Detail

MEDICARE: LISA M MAZEIKA PA-C

MEDICARE: LISA M MAZEIKA PA-C
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
1363A00000XPhysician AssistantMA001688LPA
2363A00000XPhysician AssistantBLC1791174SC

General Provider Information

NPI Number : 1982658662
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA M MAZEIKA PA-C
Provider Business Mailing Address
First Line : 460 WILLIAM HILTON PKWY
Second Line :
City : HILTON HEAD ISLAND
State : SC
Zip : 29926-2497
Country : US
Telephone Number : 843-738-4800
Fax Number : 843-738-4801
Provider Business Practice Location Address
First Line : 460 WILLIAM HILTON PKWY
Second Line :
City : HILTON HEAD ISLAND
State : SC
Zip : 29926-2497
Country : US
Telephone Number : 843-738-4800
Fax Number : 843-738-4801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 12/06/2023

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Directions to “ LISA M MAZEIKA PA-C” Practice Location

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