Provider Demographics
NPI:1265481634
Name:MASTERS, PHILIP A (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:MASTERS
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 1:3701 MARKET STREET
Mailing Address - Street 2:6TH FLOOR, SUITE 640
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5508
Mailing Address - Country:US
Mailing Address - Phone:215-662-2250
Mailing Address - Fax:
Practice Address - Street 1:3701 MARKET STREET
Practice Address - Street 2:6TH FLOOR, SUITE 640
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5508
Practice Address - Country:US
Practice Address - Phone:215-662-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045983L207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012887490001Medicaid
PA725601Medicare ID - Type Unspecified
F29642Medicare UPIN