Provider Demographics
NPI:1598313793
Name:MAST, NEIL (PA-C)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:MAST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 N MAIN ST STE 3100
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-0017
Mailing Address - Country:US
Mailing Address - Phone:937-592-9799
Mailing Address - Fax:
Practice Address - Street 1:1134 N MAIN ST STE 3100
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-0017
Practice Address - Country:US
Practice Address - Phone:937-592-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OH50.006161RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant