Provider Demographics
NPI:1720065469
Name:BRIAN JOSEPH MAZZEI DPM AND RENEE PATRICE MASON DPM PC
Entity type:Organization
Organization Name:BRIAN JOSEPH MAZZEI DPM AND RENEE PATRICE MASON DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAZZEI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:276-623-0333
Mailing Address - Street 1:1231 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-4705
Mailing Address - Country:US
Mailing Address - Phone:276-623-0333
Mailing Address - Fax:237-623-0213
Practice Address - Street 1:1231 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-4705
Practice Address - Country:US
Practice Address - Phone:276-623-0333
Practice Address - Fax:237-623-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010300940213ES0103X
VAC10300942213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009302123Medicaid
VA009302646Medicare UPIN
VA009302123Medicaid
TN3353259Medicare PIN
VAC07043Medicare PIN