Healthcare Provider Details

I. General information

NPI: 1972576007
Provider Name (Legal Business Name): ANDREW MAZUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 WEAVER ST UNIT F
FALL RIVER MA
02720-1338
US

IV. Provider business mailing address

231 WEAVER ST UNIT F
FALL RIVER MA
02720-1338
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-1400
  • Fax: 508-679-1449
Mailing address:
  • Phone: 508-679-1400
  • Fax: 508-679-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number150693
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3152570
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: