Provider Demographics
NPI:1962663534
Name:NICHOLAS J. MASCIOTRA MD PC
Entity Type:Organization
Organization Name:NICHOLAS J. MASCIOTRA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASCIOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-536-7725
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1632
Mailing Address - Country:US
Mailing Address - Phone:814-536-7725
Mailing Address - Fax:814-539-3130
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:SUITE 4C
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1632
Practice Address - Country:US
Practice Address - Phone:814-536-7725
Practice Address - Fax:814-539-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-016908-E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty