Provider Demographics
NPI:1922013382
Name:MASS, MARTIN MYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:MYRON
Last Name:MASS
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 1:580 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1115
Mailing Address - Country:US
Mailing Address - Phone:415-593-1136
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:580 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1115
Practice Address - Country:US
Practice Address - Phone:415-593-1136
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47043207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110177652OtherPALMETTO
CA110177652OtherPALMETTO
CA00G47043Medicare ID - Type Unspecified