Provider Demographics
NPI:1629158035
Name:MASCIANGELO, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MASCIANGELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-1430
Mailing Address - Country:US
Mailing Address - Phone:713-982-5900
Mailing Address - Fax:713-982-5944
Practice Address - Street 1:927 SHAW AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-1430
Practice Address - Country:US
Practice Address - Phone:713-982-5900
Practice Address - Fax:713-982-5944
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F68793Medicare UPIN
TX8431J5Medicare PIN
TX89X359Medicare PIN