Provider Demographics
NPI:1922159458
Name:ELIZABETH F. MASTEN MD & A.ROBERT MASTEN MD PA
Entity Type:Organization
Organization Name:ELIZABETH F. MASTEN MD & A.ROBERT MASTEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYLL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-422-4578
Mailing Address - Street 1:509 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-2917
Mailing Address - Country:US
Mailing Address - Phone:302-422-4581
Mailing Address - Fax:302-424-4511
Practice Address - Street 1:509 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-2917
Practice Address - Country:US
Practice Address - Phone:302-422-4581
Practice Address - Fax:302-424-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989020679207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE065577Medicare PIN