MEDICARE: JOHN M MARZO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	164844	NY

General Provider Information

NPI Number	:	1336121524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M MARZO M.D.

Provider Business Mailing Address
First Line	:	3435 MAIN ST
Second Line	:	160 FARBER HALL
City	:	BUFFALO
State	:	NY
Zip	:	14214-3001
Country	:	US
Telephone Number	:	716-829-2982
Fax Number	:	716-829-3945

Provider Business Practice Location Address
First Line	:	3435 MAIN ST
Second Line	:	160 FARBER HALL
City	:	BUFFALO
State	:	NY
Zip	:	14214-3001
Country	:	US
Telephone Number	:	716-829-2982
Fax Number	:	716-829-3945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/10/2011

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