Provider Demographics
NPI:1275723900
Name:MASERE, CONSTANT SHUBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:CONSTANT
Middle Name:SHUBERT
Last Name:MASERE
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 1:100 W PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5923
Mailing Address - Country:US
Mailing Address - Phone:252-438-3549
Mailing Address - Fax:252-438-2084
Practice Address - Street 1:100 W PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5923
Practice Address - Country:US
Practice Address - Phone:252-438-3549
Practice Address - Fax:252-438-2084
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019782207Q00000X
NC2010-00429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2076335Medicare PIN