Provider Demographics
NPI:1437283629
Name:MASTROJENI, MARIO ANTONIO
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ANTONIO
Last Name:MASTROJENI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11433 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1906
Mailing Address - Country:US
Mailing Address - Phone:301-949-2828
Mailing Address - Fax:301-949-2392
Practice Address - Street 1:11433 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1906
Practice Address - Country:US
Practice Address - Phone:301-949-2828
Practice Address - Fax:301-949-2392
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician