Provider Demographics
NPI:1780873968
Name:LAUREN M MOZDY MD
Entity type:Organization
Organization Name:LAUREN M MOZDY MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOZDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-833-1756
Mailing Address - Street 1:3233 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2507
Mailing Address - Country:US
Mailing Address - Phone:814-833-1756
Mailing Address - Fax:814-833-1671
Practice Address - Street 1:3233 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2507
Practice Address - Country:US
Practice Address - Phone:814-833-1756
Practice Address - Fax:814-833-1671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057038L261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain