Provider Demographics
NPI:1922270339
Name:JOEL P. MASCARO, D.O., P.C.
Entity Type:Organization
Organization Name:JOEL P. MASCARO, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MASCARO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-431-1152
Mailing Address - Street 1:11681 E BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-6360
Mailing Address - Country:US
Mailing Address - Phone:602-431-1152
Mailing Address - Fax:602-431-2149
Practice Address - Street 1:9449 N 90TH ST
Practice Address - Street 2:SUITE 114
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5099
Practice Address - Country:US
Practice Address - Phone:480-214-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3250OtherSTATE LICENSURE