Provider Demographics
NPI:1730352170
Name:MOZZICATO, SUSAN (MD, MHS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MOZZICATO
Suffix:
Gender:F
Credentials:MD, MHS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:ALLERGY &CLINICAL IMMUNOLOGY, DEPARTMENT OF PEDIATRICS
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-9885
Mailing Address - Fax:603-650-0907
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:ALLERGY &CLINICAL IMMUNOLOGY, DEPARTMENT OF PEDIATRICS
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-9885
Practice Address - Fax:603-650-0907
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT051787207K00000X
NH16727207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine