MEDICARE: PETER J MASCETTA D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	918	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053317164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J MASCETTA D.O

Provider Business Mailing Address
First Line	:	28 ARSENAL ST
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-5226
Country	:	US
Telephone Number	:	207-622-4231
Fax Number	:	207-623-1580

Provider Business Practice Location Address
First Line	:	6 EAST CHESTNUT STREET
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04333-0001
Country	:	US
Telephone Number	:	207-626-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/04/2008

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