Healthcare Provider Details

I. General information

NPI: 1962426684
Provider Name (Legal Business Name): THOMAS MICHAEL MAZZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E HOSPITAL DR STE 400
WEST COLUMBIA SC
29169-4800
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-3300
  • Fax: 803-936-7735
Mailing address:
  • Phone: 803-936-3300
  • Fax: 803-936-7735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number88915
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number88915
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: