Glea H Mazzuca, D.O

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OS017114 Issued in PA

Practice address

721 E Baltimore Pike
Kennett Square, PA 19348-2405

Phone

(640) 765-4200

NPI assigned

May 22, 2012

Last updated

Oct 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 5, 2024 through Feb 5, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• On Demand Urgent Care Group PC

  • Urgent Care Clinic/Center
  • Philadelphia, PA
  • NPI 1881083723
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1376803502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 E BALTIMORE PIKE",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193482405",
            "telephone_number": "610-765-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 E BALTIMORE PIKE",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193482405",
            "telephone_number": "640-765-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZUCA",
        "first_name": "GLEA",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-22",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "DE",
            "license": "C2-0012748",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS017114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kellianne Kristian Martin
• Megan Louise Martincorena, MS, CCC-SLP
• Regina S Martino, PSY.D.
• Nathalie Matte, D.C.
• Paul Mayer, MD
• Cindy McAlpin, COTA/L,CLT
• Reina McAndrew, FNP
• Haeli McCabe, DPT
• Kristina Dahne McCallum
• Roya D McCloskey, PSYD

• Internal Medicine Physician in Kennett Square, PA
• Providers in Kennett Square, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; 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.

Verify at the official NPI Registry.