Healthcare Provider Details

I. General information

NPI: 1922928233
Provider Name (Legal Business Name): PETER MAZZARO CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E PIER DR APT 2121
EAST BOSTON MA
02128-2946
US

IV. Provider business mailing address

40 E PIER DR APT 2121
EAST BOSTON MA
02128-2946
US

V. Phone/Fax

Practice location:
  • Phone: 207-939-7950
  • Fax:
Mailing address:
  • Phone: 207-939-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN10014711
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: