Healthcare Provider Details

I. General information

NPI: 1760322580
Provider Name (Legal Business Name): HEATHER KRISTEN MAZZACCARO DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 KIRTLAND ST. BLDG 1216
HANSCOM AFB MA
01731
US

IV. Provider business mailing address

7 KIRTLAND ST. BLDG 1216
HANSCOM AFB MA
01731
US

V. Phone/Fax

Practice location:
  • Phone: 781-225-2772
  • Fax:
Mailing address:
  • Phone: 781-225-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberN1-0002179
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: