Healthcare Provider Details

I. General information

NPI: 1235490061
Provider Name (Legal Business Name): NICHOLAS H. MAST, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROWLAND WAY STE 200
NOVATO CA
94945-5041
US

IV. Provider business mailing address

8 ALPINE LILY PL
SAN RAFAEL CA
94903-1090
US

V. Phone/Fax

Practice location:
  • Phone: 415-530-5330
  • Fax: 415-530-5333
Mailing address:
  • Phone: 415-353-6380
  • Fax: 415-353-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA98951
License Number StateCA

VIII. Authorized Official

Name: NICHOLAS H MAST
Title or Position: OWNER
Credential: MD
Phone: 415-530-5330