Provider Demographics
NPI:1588860282
Name:MASCARENHAS, KRISTY G (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:G
Last Name:MASCARENHAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:G
Other - Last Name:AHRLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 SAYBROOK ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4774
Mailing Address - Country:US
Mailing Address - Phone:860-347-7466
Mailing Address - Fax:860-347-2619
Practice Address - Street 1:400 SAYBROOK ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4774
Practice Address - Country:US
Practice Address - Phone:860-347-7466
Practice Address - Fax:860-347-2619
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048557207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology