Healthcare Provider Details

I. General information

NPI: 1023196136
Provider Name (Legal Business Name): LAWRENCE ALBERT MAZUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 ELM ST
CLAREMONT NH
03743-4921
US

IV. Provider business mailing address

243 ELM ST
CLAREMONT NH
03743-4921
US

V. Phone/Fax

Practice location:
  • Phone: 603-542-7771
  • Fax: 603-542-1814
Mailing address:
  • Phone: 603-542-7771
  • Fax: 603-542-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7445
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: