Healthcare Provider Details

I. General information

NPI: 1346419843
Provider Name (Legal Business Name): RICHARD J MAZZEI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 BROADWAY
BANGOR ME
04401
US

IV. Provider business mailing address

77 BROADWAY
BANGOR ME
04401
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-2788
  • Fax: 207-990-2545
Mailing address:
  • Phone: 207-947-2788
  • Fax: 207-990-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number010002
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0607063
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR030879
License Number StateME

VIII. Authorized Official

Name: RICHARD J MAZZEI
Title or Position: MD OWNER
Credential: MD
Phone: 207-947-2788