Provider Demographics
NPI:1902999097
Name:MAZADE, MARC A (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:MAZADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-6800
Practice Address - Fax:817-885-2106
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9845207RI0200X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
1750369203OtherGRP NPI NUMBER
TX2417903OtherUHC PIN
TX10031115OtherAMERIGROUP PIN
TX140442852Medicaid
TX140442879Medicaid
TX1977785OtherFIRSTHEALTH PIN
TX5871707OtherCIGNA PIN
TX810594556OtherPHCS PIN
TX5286480OtherCCN PIN
TX7010336OtherAETNA PIN
TX124161OtherSUPERIOR PIN
TX137345810Medicaid
TX8A9113OtherBCBSTX IND PIN
TX106131904Medicaid
TX118835101OtherFIRSTCARE PIN
TX140442879Medicaid
TX8B5701Medicare PIN
TX8A9113OtherBCBSTX IND PIN