Individual
RUSSELL F. MAZDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
140 NUTT RD, PHOENIXVILLE, PA 19460-3906
(610) 983-1221
Mailing address
PO BOX 425, LEDERACH, PA 19450-0425
(800) 528-0006
(732) 349-6030
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS004596L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010174790010
—
PA
01
—
0033070000
PERSONAL CHOICE/KHPE
PA
01
—
30021002
KEYSTONE MERCY HP
PA
01
—
457175
HIGHMARK BLUE SHIELD
PA
01
—
8821743
CIGNA HMO/PPO
PA
01
—
OS004596L
HEALTH PARTNERS
PA
Enumeration date
04/12/2006
Last updated
09/09/2011
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