Provider Demographics
NPI:1033868252
Name:MISTARZ, AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:MISTARZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4927 SHAFER ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2735
Mailing Address - Country:US
Mailing Address - Phone:540-520-8632
Mailing Address - Fax:
Practice Address - Street 1:4927 SHAFER ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2735
Practice Address - Country:US
Practice Address - Phone:540-520-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program