Individual
AUGUSTUS MAZZOCCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, SPORTS MEDICINE, FARMINGTON, CT 06030-0001
(860) 679-6600
(860) 679-6604
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
037674
CT
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
037674
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376749
—
CT
Enumeration date
06/23/2005
Last updated
04/08/2022
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