Provider Demographics
NPI:1972586766
Name:MASTRIAN, MARGARET M (OD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:MASTRIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-342-5313
Mailing Address - Fax:724-342-5318
Practice Address - Street 1:490 N KERRWOOD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5202
Practice Address - Country:US
Practice Address - Phone:724-342-2733
Practice Address - Fax:724-342-6652
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0807121Medicaid
PA001214422Medicaid
PAU04503Medicare UPIN
PA629688RN0Medicare PIN