Provider Demographics
NPI:1417954264
Name:MASTRIANNI, DAVID MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:MASTRIANNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 CARE LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8623
Mailing Address - Country:US
Mailing Address - Phone:518-226-6000
Mailing Address - Fax:518-226-6001
Practice Address - Street 1:3 CARE LN
Practice Address - Street 2:SUITE 300
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8623
Practice Address - Country:US
Practice Address - Phone:518-226-6000
Practice Address - Fax:518-226-6001
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY195174207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400084847Medicare PIN
F44080Medicare UPIN