Provider Demographics
NPI:1932399698
Name:MAST, NICHOLAS H (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:H
Last Name:MAST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8 ALPINE LILY PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1090
Mailing Address - Country:US
Mailing Address - Phone:415-530-5330
Mailing Address - Fax:
Practice Address - Street 1:100 ROWLAND WAY STE 200
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5041
Practice Address - Country:US
Practice Address - Phone:415-530-5330
Practice Address - Fax:415-530-5333
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2023-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV12254207X00000X
UT5401485-1205207X00000X
CODR.0061770207X00000X
CAA98951207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery