Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 223341 | MA |
N | 111NI0900X | Internist | 223341 | MA |
N | 207RC0000X | Internist - Cardiovascular Disease | 223341 | MA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 20159 | NH |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 223341 | MA |
NPI | 1073551354 |
---|---|
Provider Name | Michael J Mazzini |
First Address | Stoneham, MA 02180-1714 |
Second Address | Boston, MA 02118-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 24/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110086025A | (05) | MA |
3119927 | (05) | NH |