Healthcare Provider Details

I. General information

NPI: 1477846079
Provider Name (Legal Business Name): TRESA REENA MASCARENHAS MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 STANTON CHRISTIANA RD STE 202
NEWARK DE
19713-2148
US

IV. Provider business mailing address

537 STANTON CHRISTIANA RD STE 202
NEWARK DE
19713-2148
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-9692
  • Fax: 302-994-9803
Mailing address:
  • Phone: 302-994-9692
  • Fax: 302-994-9803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberC10011090
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: