Basic Information
| Provider Information | |||||||||
| NPI: | 1528158227 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZZELLA | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708166038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255260001 | ||||||||
| FaxNumber: | 2257659196 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712017407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189664541 | ||||||||
| FaxNumber: | 3189664543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | CV2005119 | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 200101093 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 208M00000X | 44676 | KY | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | DR0051332 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 200101093 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 311477 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | N0109A | 05 | SC | MEDICAID | 5900336 | 05 | NC | MEDICAID | 7100184720 | 05 | KY | MEDICAID |