Healthcare Provider Details

I. General information

NPI: 1639334824
Provider Name (Legal Business Name): KATHERINE SARAH MASTRIANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD STE 300
CHARLOTTE NC
28207-1112
US

IV. Provider business mailing address

PO BOX 604350
CHARLOTTE NC
28260-4350
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-0741
  • Fax:
Mailing address:
  • Phone: 828-213-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2014-01058
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2014-01058
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number2014-01058
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL31047
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: