Provider Demographics
NPI:1275119208
Name:MASCHARI, DOMINIC MICHAEL (PA-S)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:MICHAEL
Last Name:MASCHARI
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 TURNBURY ST APT A1
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4965
Mailing Address - Country:US
Mailing Address - Phone:419-602-1952
Mailing Address - Fax:
Practice Address - Street 1:1202 TURNBURY ST APT A1
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4965
Practice Address - Country:US
Practice Address - Phone:419-602-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program