Healthcare Provider Details

I. General information

NPI: 1073551354
Provider Name (Legal Business Name): MICHAEL J MAZZINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVE PRESTON, 3RD FLOOR
BOSTON MA
02118-2309
US

IV. Provider business mailing address

3 WOODLAND RD STE 421
STONEHAM MA
02180-1714
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-7490
  • Fax: 617-414-8742
Mailing address:
  • Phone: 617-414-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number223341
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number20159
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number223341
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number223341
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: