Healthcare Provider Details

I. General information

NPI: 1114978194
Provider Name (Legal Business Name): LOUIS MAZZARELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MONTAUK AVE
NEW LONDON CT
06320-4700
US

IV. Provider business mailing address

365 MONTAUK AVE MC28
NEW LONDON CT
06320-4700
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-0711
  • Fax:
Mailing address:
  • Phone: 860-442-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number45115
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD15924
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number226488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: