Provider Demographics
NPI:1477845428
Name:MASKA, EDLIRA (MD)
Entity type:Individual
Prefix:
First Name:EDLIRA
Middle Name:
Last Name:MASKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6103
Mailing Address - Country:US
Mailing Address - Phone:561-472-2583
Mailing Address - Fax:561-472-2527
Practice Address - Street 1:10101 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6103
Practice Address - Country:US
Practice Address - Phone:561-472-2590
Practice Address - Fax:561-227-0161
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN16048207R00000X
FLME119335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011710200Medicaid
FLHU310ZMedicare PIN