Individual
LAUREN WASSON MAZZURCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
825 FAIRFAX AVE, SUITE 201, NORFOLK, VA 23507-1914
(757) 446-7040
(757) 446-7049
Mailing address
PO BOX 936, EVMS MEDICAL GROUP, NORFOLK, VA 23501-0936
(757) 446-7040
(757) 446-7049
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
0102203859
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-022
TRICARE/CHAMPUS
VA
01
—
1750521464
VIRGINIA HEALTH NETWORK
VA
05
—
1750521464
—
NC
05
—
1750521464
—
VA
01
—
433416
ANTHEM
VA
01
—
PAR
MULTIPLAN
VA
Enumeration date
02/20/2009
Last updated
08/31/2015
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