Provider Demographics
NPI:1417933508
Name:MAUZY, MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MAUZY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-3156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1861 N PLEASANTS HWY # 101
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-8511
Practice Address - Country:US
Practice Address - Phone:681-612-1022
Practice Address - Fax:304-447-2556
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1661207Q00000X
OH34.006811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055328000Medicaid
OH2952667Medicaid
WV001718435OtherMOUNTAIN STATE BCBS
WV1417933508OtherMOUNTAIN STATE BCBS
P00375985OtherRAILROAD MEDICARE
WVWV01661AOtherHEALTH PLAN
WVWV01661AOtherHEALTH PLAN
WVG72493Medicare UPIN
WVWV01661AOtherHEALTH PLAN
WV4203481Medicare PIN
WV1417933508OtherMOUNTAIN STATE BCBS
WVMA7247211Medicare ID - Type Unspecified