Provider Demographics
NPI:1598857401
Name:MASTOR, JASON ELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ELIA
Last Name:MASTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:206 JOE V KNOX AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7911
Mailing Address - Country:US
Mailing Address - Phone:704-662-6500
Mailing Address - Fax:704-662-6503
Practice Address - Street 1:206 JOE V KNOX AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7911
Practice Address - Country:US
Practice Address - Phone:704-662-6500
Practice Address - Fax:704-662-6503
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2004010952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913799Medicaid
NC8913799Medicaid
NC2340122Medicare ID - Type UnspecifiedCIGNA MEDICARE
NC2032847Medicare PIN