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NPI Code Detail

MEDICARE: DR. KRISTIE LYNNE MAST M.D.

MEDICARE: DR. KRISTIE LYNNE MAST M.D.
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
1207Q00000XFamily Medicine PhysicianMD067538LPA

Other Identifiers

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

General Provider Information

NPI Number : 1922058759
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIE LYNNE MAST M.D.
Provider Business Mailing Address
First Line : 4417 N 6TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-2319
Country : US
Telephone Number : 215-302-3600
Fax Number : 215-329-2369
Provider Business Practice Location Address
First Line : 4417 N 6TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-2319
Country : US
Telephone Number : 215-302-3600
Fax Number : 215-329-2369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 04/22/2025

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