Healthcare Provider Details

I. General information

NPI: 1083790745
Provider Name (Legal Business Name): JOHN ROBERT MASCOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL NAVAL MEDICAL CTR 8901 ROCKVILLE PIKE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

VACCINE RESEARCH CENTER NIAID NIH 40 CONVENT DRIVE, MSC 3015
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4611
  • Fax:
Mailing address:
  • Phone: 301-594-8487
  • Fax: 301-480-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG59935
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberG59935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: