Healthcare Provider Details

I. General information

NPI: 1538369012
Provider Name (Legal Business Name): LOREN L. MASTERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE #3500
AKRON OH
44307-2432
US

IV. Provider business mailing address

1 AKRON GENERAL AVE #3500
AKRON OH
44307-2432
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-1400
  • Fax: 330-344-0112
Mailing address:
  • Phone: 330-344-1400
  • Fax: 330-344-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35-121901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: