Healthcare Provider Details

I. General information

NPI: 1831178342
Provider Name (Legal Business Name): MARCEL M MAZZONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 QUINCY AVE SUITE 2
SCRANTON PA
18510-1739
US

IV. Provider business mailing address

1401 ELECTRIC ST
DUNMORE PA
18509-2098
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-0851
  • Fax: 570-344-4285
Mailing address:
  • Phone: 570-969-9005
  • Fax: 570-969-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD065494L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: