Provider Demographics
NPI:1679776157
Name:MASCARENHAS, DON J (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:J
Last Name:MASCARENHAS
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 1:3700 SOUTHERN BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1226
Mailing Address - Country:US
Mailing Address - Phone:937-643-9299
Mailing Address - Fax:937-643-2343
Practice Address - Street 1:3700 SOUTHERN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1226
Practice Address - Country:US
Practice Address - Phone:937-643-9299
Practice Address - Fax:937-643-2343
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126656208100000X
FLME99009208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278624900Medicaid
OH0144369Medicaid
OHH438380Medicare PIN
FL278624900Medicaid