Healthcare Provider Details

I. General information

NPI: 1508810938
Provider Name (Legal Business Name): MATHIAS A. MASEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GRAND AVE SUITE 600
OAKLAND CA
94612-3744
US

IV. Provider business mailing address

80 GRAND AVE SUITE 600
OAKLAND CA
94612-3744
US

V. Phone/Fax

Practice location:
  • Phone: 510-763-0884
  • Fax: 510-763-1574
Mailing address:
  • Phone: 510-763-0884
  • Fax: 510-763-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG34134
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG34134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: