Provider Demographics
NPI:1649240052
Name:MASTERSON, MICHAEL DENIS (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DENIS
Last Name:MASTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:DENIS
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1250 LA VENTA
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-496-5153
Mailing Address - Fax:805-496-5202
Practice Address - Street 1:1250 LA VENTA
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-496-5153
Practice Address - Fax:805-496-5202
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27552207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG27552AOtherMEDICARE PTAN
CAG27552OtherMEDICAL LICENSE
CAW22342Medicare PIN
CAW22342Medicare UPIN