Provider Demographics
NPI:1912966300
Name:MASRY, MATTHEW SALAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SALAH
Last Name:MASRY
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 1:88TH MEDICAL GROUP
Mailing Address - Street 2:4881 SUGAR MAPLE DR
Mailing Address - City:WRIGHT PATTERSON
Mailing Address - State:OH
Mailing Address - Zip Code:45433-2259
Mailing Address - Country:US
Mailing Address - Phone:937-713-4482
Mailing Address - Fax:
Practice Address - Street 1:88TH MEDICAL GROUP
Practice Address - Street 2:4881 SUGAR MAPLE DR
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-713-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233205207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH07601Medicare UPIN