Provider Demographics
NPI:1235490061
Name:NICHOLAS H. MAST, M.D., INC.
Entity Type:Organization
Organization Name:NICHOLAS H. MAST, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-530-5330
Mailing Address - Street 1:8 ALPINE LILY PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1090
Mailing Address - Country:US
Mailing Address - Phone:415-353-6380
Mailing Address - Fax:415-353-6462
Practice Address - Street 1:100 ROWLAND WAY STE 200
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5041
Practice Address - Country:US
Practice Address - Phone:415-530-5330
Practice Address - Fax:415-530-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98951207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty