Provider Demographics
NPI:1053317164
Name:MASCETTA, PETER J (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:MASCETTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5226
Mailing Address - Country:US
Mailing Address - Phone:207-622-4231
Mailing Address - Fax:207-623-1580
Practice Address - Street 1:6 EAST CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0001
Practice Address - Country:US
Practice Address - Phone:207-626-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME9182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2861000099Medicaid
MEMM2446Medicare Oscar/Certification
MPMM244601Medicare PIN
ME2861000099Medicaid