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NPI Code Detail

MEDICARE: DR. THOMAS M MASTERSON MD

MEDICARE: DR. THOMAS M MASTERSON MD
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
1207R00000XInternal Medicine Physician0101038350VA
2207R00000XInternal Medicine PhysicianD50534MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10101038350OTHERVAMEDICAL LICENSE

General Provider Information

NPI Number : 1649224643
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS M MASTERSON MD
Provider Business Mailing Address
First Line : 2100 POWELL ST
Second Line : STE 900
City : EMERYVILLE
State : CA
Zip : 94608-1844
Country : US
Telephone Number : 510-350-2842
Fax Number : 510-879-9128
Provider Business Practice Location Address
First Line : 9106 PINE VIEW LN
Second Line :
City : CLINTON
State : MD
Zip : 20735-3229
Country : US
Telephone Number : 703-356-2037
Fax Number : 703-734-8987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 09/30/2017

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