Basic Information
| Provider Information | |||||||||
| NPI: | 1619028222 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NICHOLAS P MASTROS MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402667006 | ||||||||
| FaxNumber: | 7402667049 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402667006 | ||||||||
| FaxNumber: | 7402667049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | MASTROS | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7402667006 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0007X | 68080 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck |
ID Information
| ID | Type | State | Issuer | Description | 0186310 | 05 | OH | MEDICAID |