Healthcare Provider Details

I. General information

NPI: 1003879446
Provider Name (Legal Business Name): PASQUALE MASONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 MAIN ST SUITE 301
BRIDGEPORT CT
06606-4237
US

IV. Provider business mailing address

3180 MAIN ST SUITE 301
BRIDGEPORT CT
06606-4237
US

V. Phone/Fax

Practice location:
  • Phone: 203-373-9100
  • Fax: 203-365-8492
Mailing address:
  • Phone: 203-373-9100
  • Fax: 203-365-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number025528
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25528
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: