Provider Demographics
NPI:1891314241
Name:MASTRACCO FOOT & ANKLE LTD
Entity Type:Organization
Organization Name:MASTRACCO FOOT & ANKLE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTRACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-244-8989
Mailing Address - Street 1:6227 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8439
Mailing Address - Country:US
Mailing Address - Phone:330-244-8989
Mailing Address - Fax:
Practice Address - Street 1:6227 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8439
Practice Address - Country:US
Practice Address - Phone:330-244-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty