Basic Information
| Provider Information | |||||||||
| NPI: | 1437123981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASTERS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2828 STERRETTANIA RD | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165063050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148339700 | ||||||||
| FaxNumber: | 8148354301 | ||||||||
| Practice Location | |||||||||
| Address1: | 2828 STERRETTANIA RD | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165063050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148339700 | ||||||||
| FaxNumber: | 8148354301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS005118L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MA131352 | 01 | PA | HIGHMARK | OTHER | 4468622 | 01 | AETNA | OTHER | 00040788601 | 01 | UNIVERA | OTHER | 0009248520011 | 05 | PA | MEDICAID | 253213 | 01 | UPMC | OTHER |