Healthcare Provider Details

I. General information

NPI: 1558856914
Provider Name (Legal Business Name): RYAN MASI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-8680
  • Fax: 207-622-8681
Mailing address:
  • Phone: 207-622-8680
  • Fax: 207-622-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP2828
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: