Provider Demographics
NPI:1235314394
Name:MASTERTON, DEIRDRE C (MD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:C
Last Name:MASTERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WALTER E FORAN BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4668
Mailing Address - Country:US
Mailing Address - Phone:908-284-5295
Mailing Address - Fax:908-806-8570
Practice Address - Street 1:4 WALTER E FORAN BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4664
Practice Address - Country:US
Practice Address - Phone:908-284-5295
Practice Address - Fax:908-806-8570
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11711207V00000X
RILP00728207V00000X
NJ25MA08984000207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2A6116OtherPTAN