Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 010300940 | VA |
N | 213ES0103X | Foot & Ankle Surgery | 450 | TN |
NPI | 1063496008 |
---|---|
Provider Name | Brian J Mazzei |
First Address | Abingdon, VA 24210-4705 |
Second Address | Abingdon, VA 24210-4705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 27/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
118872001 | ADMINISTAR FEDERAL (01) | |
118872001 | DME (01) | |
1480758 | UMWA (01) | |
280049 | ANTHEM (01) | VA |
4350350 | (05) | TN |
9300732 | (05) | VA |
U52230 | (02) | VA |