Provider Demographics
NPI:1174569354
Name:MAZEPA, MARSHALL A (MD)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:A
Last Name:MAZEPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA
Mailing Address - Street 2:420 DELAWARE ST SE, MAYO MAIL CODE 480
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:608-215-0658
Mailing Address - Fax:
Practice Address - Street 1:M HEALTH CENTER FOR BLEEDING AND CLOTTING DISORDERS
Practice Address - Street 2:2512 S 7TH ST, SUITE 105
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC157749207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology