Healthcare Provider Details

I. General information

NPI: 1750451258
Provider Name (Legal Business Name): MARC MASKOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 HOWE AVE SUITE 225
SACRAMENTO CA
95825-3365
US

IV. Provider business mailing address

1321 HOWE AVE SUITE 225
SACRAMENTO CA
95825-3365
US

V. Phone/Fax

Practice location:
  • Phone: 916-564-2225
  • Fax: 916-564-5926
Mailing address:
  • Phone: 916-564-2225
  • Fax: 916-564-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberA97386
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA97386
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA97386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: