=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477988764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSEMARY MAZANET MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2013
-----------------------------------------------------
Last Update Date | 09/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 DAFFODIL LN
-----------------------------------------------------
City | COS COB
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06807-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-861-0077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 DAFFODIL LN
-----------------------------------------------------
City | COS COB
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06807-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-861-0077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 039910
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------