Basic Information
| Provider Information | |||||||||
| NPI: | 1871980326 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MOZINGO | ||||||||
| FirstName: | CY | ||||||||
| MiddleName: | MARSHALL | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| Address2: | N2198 UNC HOSPITALS CAMPUS BOX 7010 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665136 | ||||||||
| FaxNumber: | 9849744873 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265061200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6813423455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 04/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 209644 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 29681 | WV | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 29681 | 01 | WV | WV LICENSE | OTHER |