Healthcare Provider Details

I. General information

NPI: 1083704472
Provider Name (Legal Business Name): A.. ROBERT MASTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: A. ROBERT MASTEN M.D.

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 LAKEVIEW AVE
MILFORD DE
19963-2917
US

IV. Provider business mailing address

509 LAKEVIEW AVE
MILFORD DE
19963-2917
US

V. Phone/Fax

Practice location:
  • Phone: 302-422-4581
  • Fax: 302-424-4511
Mailing address:
  • Phone: 302-422-4581
  • Fax: 302-424-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberC1-0001516
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC1-0001516
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberC1-0001516
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: