Provider Demographics
NPI:1487856050
Name:MARC MASKOWITZ MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARC MASKOWITZ MD, A PROFESSIONAL CORPORATION
Other - Org Name:PAINCARE MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MASKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-564-2225
Mailing Address - Street 1:1321 HOWE AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3365
Mailing Address - Country:US
Mailing Address - Phone:916-564-2225
Mailing Address - Fax:916-564-5926
Practice Address - Street 1:1321 HOWE AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3365
Practice Address - Country:US
Practice Address - Phone:916-564-2225
Practice Address - Fax:916-564-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97386208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05629ZMedicare PIN
I69193Medicare UPIN