Provider Demographics
NPI:1861470163
Name:MASTELLER, MARK H (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:MASTELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E 38TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-3688
Mailing Address - Country:US
Mailing Address - Phone:814-825-4262
Mailing Address - Fax:
Practice Address - Street 1:2240 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-3688
Practice Address - Country:US
Practice Address - Phone:814-825-4262
Practice Address - Fax:814-825-2616
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006889L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine