NPIMap

Organization Active NPI

Old Town M.D.

  • Internal Medicine Physician
  • Sanford, NC
National Provider Identifier
1417566779
Registry record updated Jul 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
OLD TOWN M.D.
Practice address
500 Westover Dr Ste 10417
Sanford, NC 27330-8941
Phone
(704) 709-9362
NPI assigned
Jul 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2020

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

Authorized official

Name
Dr. William J. Mazzella, M.D.NPI 1528158227
Title
President
Phone
(704) 709-9362

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

500 Westover Dr Ste 10417
Sanford, NC 27330-8941

Mailing address

500 Westover Dr Ste 10417
Sanford, NC 27330-8941
Phone (704) 709-9362

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595462400000",
    "number": "1417566779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WESTOVER DR STE 10417",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273308941",
            "telephone_number": "704-709-9362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WESTOVER DR STE 10417",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273308941",
            "telephone_number": "704-709-9362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-23",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A",
        "authorized_official_last_name": "MAZZELLA",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-709-9362",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.