Healthcare Provider Details

I. General information

NPI: 1205954393
Provider Name (Legal Business Name): VINCENT JOSEPH MASE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CEDAR ST # BB205
NEW HAVEN CT
06510
US

IV. Provider business mailing address

330 CEDAR ST # BB205
NEW HAVEN CT
06510-3218
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4931
  • Fax:
Mailing address:
  • Phone: 203-785-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0600003444
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number61850
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: