Provider Demographics
NPI:1437133154
Name:MASI, ANTHONY V (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:V
Last Name:MASI
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 1:4699 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1830
Mailing Address - Country:US
Mailing Address - Phone:203-374-8182
Mailing Address - Fax:203-374-2626
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1830
Practice Address - Country:US
Practice Address - Phone:203-374-8182
Practice Address - Fax:203-374-2626
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013788207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB39524Medicare UPIN
180000902Medicare ID - Type Unspecified