MEDICARE: DR. ERIC B MASTERNICK D.P.M.

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	213E00000X	Podiatrist	0103300997	VA

General Provider Information

NPI Number	:	1396743688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC B MASTERNICK D.P.M.

Provider Business Mailing Address
First Line	:	1600 E GUDE DR
Second Line	:	SUITE 200
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-1341
Country	:	US
Telephone Number	:	301-933-7133
Fax Number	:	301-933-7137

Provider Business Practice Location Address
First Line	:	1860 TOWN CENTER DR
Second Line	:	SUITE 220
City	:	RESTON
State	:	VA
Zip	:	20190-5896
Country	:	US
Telephone Number	:	703-391-0211
Fax Number	:	703-880-1192

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	12/24/2015

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