Provider Demographics
NPI:1801961982
Name:MASKARINEC, JOHN K (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:MASKARINEC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DEVON PL
Mailing Address - Street 2:SUITE 215
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6482
Mailing Address - Country:US
Mailing Address - Phone:330-673-9501
Mailing Address - Fax:330-673-8204
Practice Address - Street 1:401 DEVON PL
Practice Address - Street 2:SUITE 215
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6482
Practice Address - Country:US
Practice Address - Phone:330-673-9501
Practice Address - Fax:330-673-8204
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0467543Medicaid
OHMA7256991Medicare ID - Type Unspecified
OH0467543Medicaid