Provider Demographics
NPI:1801881495
Name:MASTERS, STUART J (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:J
Last Name:MASTERS
Suffix:
Gender:M
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:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:NY
Mailing Address - Zip Code:12125-0417
Mailing Address - Country:US
Mailing Address - Phone:518-794-7216
Mailing Address - Fax:518-794-0180
Practice Address - Street 1:501 STATE RTE 20
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:NY
Practice Address - Zip Code:12125
Practice Address - Country:US
Practice Address - Phone:518-794-7216
Practice Address - Fax:518-794-0180
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38710174400000X, 2085R0202X
NY2324652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00579951Medicaid
NY728S71OtherMEDICARE
MA2045281Medicaid
NY00579951Medicaid
MA2045281Medicaid