ELENORA MAZOVER , NPI 1952481467 — AUGUSTA (GA)

NPI 1952481467

13+ Years Experience Individual

ELENORA MAZOVER

10/17/2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1952481467
NPI NUMBER

About ELENORA MAZOVER

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

ELENORA MAZOVER is a provider established in AUGUSTA, GA. The NPI number of ELENORA MAZOVER is 1952481467 and was assigned on 10/17/2006. The practitioners primary taxonomy code is: 363AM0700X with license number: 1400 GA .

Mailing address

  • City: AUGUSTA
  • State: GA
  • Postal code: 309072464
  • Address: 804 SCOTT NIXON MEMORIAL DR

Primary Practice Address

  • Region : AUGUSTA, GA
  • NPI : 1952481467
  • Phone : 8003944445
  • Postalcode : 309072464
  • Address : 804 SCOTT NIXON MEMORIAL DR

Additional identifiers

  • Identifier: 20841
  • Code / Type : 1 - other
  • Identifier state : MD
  • Identifier issuer: ZIP CODE

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Physician Assistant

  • Taxonomy code: 363AM0700X
  • License number: 1400
  • License state: GA

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • ELENORA MAZOVER
  • Address : 804 SCOTT NIXON MEMORIAL DR
  • Region : AUGUSTA, GA
  • NPI : 1952481467
  • Phone : 8003944445
  • Postalcode : 309072464

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address804 SCOTT NIXON MEMORIAL DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameAUGUSTA
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameGA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code309072464
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number8003944445
The telephone number associated with the location address of the provider being identified.
NPI1952481467
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1363AM0700X
Provider Enumeration Date10/17/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)ELENORA MAZOVER
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address804 SCOTT NIXON MEMORIAL DR
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameAUGUSTA
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameGA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code309072464
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Healthcare Provider Taxonomy Code #1363AM0700X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Physician Assistant
Provider License Number 11400
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1GA
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 120841
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1MD
Other Provider Identifier State #1
Other Provider Identifier Issuer 1ZIP CODE
Other Provider Identifier Issuer #1
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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