Provider Demographics
NPI:1750570453
Name:D. NEAL MASTRUSERIO, M.D., LLC
Entity type:Organization
Organization Name:D. NEAL MASTRUSERIO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:MASTRUSERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-442-6647
Mailing Address - Street 1:3380 TREMONT RD STE 140
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2140
Mailing Address - Country:US
Mailing Address - Phone:614-442-6647
Mailing Address - Fax:614-442-6648
Practice Address - Street 1:3380 TREMONT RD STE 140
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2140
Practice Address - Country:US
Practice Address - Phone:614-442-6647
Practice Address - Fax:614-442-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072392M207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty