Provider Demographics
NPI:1396743688
Name:MASTERNICK, ERIC B (DPM)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:B
Last Name:MASTERNICK
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:1600 E GUDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1341
Mailing Address - Country:US
Mailing Address - Phone:301-933-7133
Mailing Address - Fax:301-933-7137
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 220
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-391-0211
Practice Address - Fax:703-880-1192
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2015-12-24
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Provider Licenses
StateLicense IDTaxonomies
VA0103300997213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC144947YFCTMedicare PIN