Provider Demographics
NPI:1407060973
Name:MASTASCUSA, MARIBETH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:
Last Name:MASTASCUSA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 OXFORD DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1896
Mailing Address - Country:US
Mailing Address - Phone:412-854-3121
Mailing Address - Fax:412-641-6824
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:ROOM 9055
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:412-802-8271
Practice Address - Fax:412-647-4486
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004071G363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034220D51Medicare ID - Type Unspecified