Provider Demographics
NPI:1851071252
Name:MASCARELLA, GEORGE R (CPRS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:R
Last Name:MASCARELLA
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BOARDMAN CANFIELD RD STE C4
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4367
Mailing Address - Country:US
Mailing Address - Phone:855-292-9778
Mailing Address - Fax:
Practice Address - Street 1:725 BOARDMAN CANFIELD RD STE C4
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4367
Practice Address - Country:US
Practice Address - Phone:855-292-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004177175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist