Provider Demographics
NPI:1710130018
Name:JOSEPH B MASTERNICK DO INC
Entity Type:Organization
Organization Name:JOSEPH B MASTERNICK DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-4568
Mailing Address - Street 1:PO BOX 14290
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-7290
Mailing Address - Country:US
Mailing Address - Phone:330-758-4568
Mailing Address - Fax:330-758-5683
Practice Address - Street 1:914 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5007
Practice Address - Country:US
Practice Address - Phone:330-758-4568
Practice Address - Fax:330-758-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2093208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty