Healthcare Provider Details

I. General information

NPI: 1053242420
Provider Name (Legal Business Name): JENNIFER MARIE MAZZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NEAL AVENUE
MARION CENTER PA
15759
US

IV. Provider business mailing address

835 HOSPITAL RD
INDIANA PA
15701-3629
US

V. Phone/Fax

Practice location:
  • Phone: 724-397-5571
  • Fax:
Mailing address:
  • Phone: 724-357-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT236260
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: