Provider Demographics
NPI:1083704472
Name:MASTEN, A.. ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:A..
Middle Name:ROBERT
Last Name:MASTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:ROBERT
Other - Last Name:MASTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:509 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-2917
Mailing Address - Country:US
Mailing Address - Phone:302-422-4581
Mailing Address - Fax:302-424-4511
Practice Address - Street 1:509 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-2917
Practice Address - Country:US
Practice Address - Phone:302-422-4581
Practice Address - Fax:302-424-4511
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0001516207NI0002X, 207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC48562Medicare UPIN
DE065577Medicare PIN