Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS009517L | PA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS009517-L | PA |
NPI | 1588618730 |
---|---|
Provider Name | Dr. Frank Mazzotta |
First Address | Philadelphia, PA 19148-3549 |
Second Address | Philadelphia, PA 19148-3549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G6588 | (02) | PA |