Provider Demographics
NPI:1366406837
Name:MAZOUE, CHRISTOPHER GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:MAZOUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22265
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4473
Mailing Address - Country:US
Mailing Address - Phone:803-296-7846
Mailing Address - Fax:803-296-9699
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:SUITE 404
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-434-6812
Practice Address - Fax:803-434-7306
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24044207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT81818Medicaid
SC0534520001OtherMEDICARE DME
SC0534520001Medicare NSC
H65854Medicare UPIN
SCAA47243357Medicare PIN
H658542488Medicare ID - Type Unspecified
SCH658542488Medicare PIN