Provider Demographics
NPI:1588661664
Name:MASCARENHAS, BORYS A (MD)
Entity Type:Individual
Prefix:
First Name:BORYS
Middle Name:A
Last Name:MASCARENHAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-0558
Mailing Address - Country:US
Mailing Address - Phone:352-742-2286
Mailing Address - Fax:352-742-2289
Practice Address - Street 1:1879 NIGHTINGALE LN
Practice Address - Street 2:STE B4
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4363
Practice Address - Country:US
Practice Address - Phone:352-742-2286
Practice Address - Fax:352-742-2289
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME853892086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26485700Medicaid
FLP00066305Medicare PIN
FL17534Medicare PIN
FLH63804Medicare UPIN