Provider Demographics
NPI:1669562583
Name:MASH, MICHAEL JOHN (MD LLC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MASH
Suffix:
Gender:M
Credentials:MD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1639 DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-5414
Mailing Address - Country:US
Mailing Address - Phone:610-272-2272
Mailing Address - Fax:610-279-6286
Practice Address - Street 1:1639 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-5414
Practice Address - Country:US
Practice Address - Phone:610-272-2272
Practice Address - Fax:610-279-6286
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027851E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0045906000OtherBCBS
0045906000OtherEMPLOYER ID#
PA0921387Medicaid
0045906000OtherEMPLOYER ID#
C33776Medicare UPIN