Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 271999 | MA |
NPI | 1366963258 |
---|---|
Provider Name | Maria Antonietta Mazzola |
First Address | Worcester, MA 01655-0002 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2017 |
Last Update Date | 05/07/2021 |