Active NPI
Dominic Louis Mazza, M.D.
- Psychosomatic Medicine Physician
- Archbald, PA
National Provider Identifier
1265650063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychosomatic Medicine Physician
- License
- 04318E
- Practice address
- 398 Kennedy Dr
Archbald, PA 18403-1582 - Phone
- (570) 876-1663
- Fax
- (570) 876-8223
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychosomatic Medicine Physician | 2084P0015X | 04318E | PA | Primary |
Addresses
Primary practice location
398 Kennedy Dr
Archbald, PA 18403-1582
Mailing address
398 Kennedy Dr
Archbald, PA 18403-1582
Phone (570) 876-1663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2016 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04318E | PA | MD | Psychosomatic Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455667200000",
"number": "1265650063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "398 KENNEDY DR",
"city": "ARCHBALD",
"state": "PA",
"postal_code": "184031582",
"telephone_number": "570-876-1663",
"fax_number": "570-876-8223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "398 KENNEDY DR",
"city": "ARCHBALD",
"state": "PA",
"postal_code": "184031582",
"telephone_number": "570-876-1663",
"fax_number": "570-876-8223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZA",
"first_name": "DOMINIC",
"middle_name": "LOUIS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2016-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0015X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychosomatic Medicine",
"state": "PA",
"license": "04318E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Archbald, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.