Healthcare Provider Details

I. General information

NPI: 1629040845
Provider Name (Legal Business Name): WAYNE E MASHAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

251 SALINA MEADOWS PKWY STE 100
SYRACUSE NY
13212-4516
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-4680
  • Fax: 207-622-4085
Mailing address:
  • Phone: 315-464-2000
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number278096
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number278096
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberS5430
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD072744L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME129110
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD19452
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: