Provider Demographics
NPI:1740472562
Name:MASCARELLO, JAMES T (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:MASCARELLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VIVIGEN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5600
Mailing Address - Country:US
Mailing Address - Phone:505-438-2222
Mailing Address - Fax:505-438-2200
Practice Address - Street 1:2000 VIVIGEN WAY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5600
Practice Address - Country:US
Practice Address - Phone:505-438-2222
Practice Address - Fax:505-438-2200
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCQP33442207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCQP33442OtherN Y STATE DEPT OF HEALTH