Provider Demographics
NPI:1629040845
Name:MASHAS, WAYNE E (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:E
Last Name:MASHAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:251 SALINA MEADOWS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:35 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8160
Practice Address - Country:US
Practice Address - Phone:207-621-4680
Practice Address - Fax:207-622-4085
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY278096208600000X, 2086S0102X
TXS54302086S0102X
PAMD072744L2086S0102X
FLME1291102086S0102X
MEMD19452208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02157748Medicaid
PA020050007OtherRR MEDICARE PIN
PAGU040042OtherPA MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA001833910001Medicaid
PACC9269OtherRR MEDICARE GROUP