Provider Demographics
NPI:1508810938
Name:MASEM, MATHIAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHIAS
Middle Name:A
Last Name:MASEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:80 GRAND AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3744
Mailing Address - Country:US
Mailing Address - Phone:510-763-0884
Mailing Address - Fax:510-763-1574
Practice Address - Street 1:80 GRAND AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3744
Practice Address - Country:US
Practice Address - Phone:510-763-0884
Practice Address - Fax:510-763-1574
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG34134207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G341340Medicaid
CA6031100001Medicare NSC
CA00G341340Medicare PIN
CAA45795Medicare UPIN