Healthcare Provider Details

I. General information

NPI: 1619028222
Provider Name (Legal Business Name): NICHOLAS P MASTROS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 SUNSET BLVD
STEUBENVILLE OH
43952
US

IV. Provider business mailing address

2315 SUNSET BLVD
STEUBENVILLE OH
43952
US

V. Phone/Fax

Practice location:
  • Phone: 740-266-7006
  • Fax: 740-266-7049
Mailing address:
  • Phone: 740-266-7006
  • Fax: 740-266-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number68080
License Number StateOH

VIII. Authorized Official

Name: ANGELA MASTROS
Title or Position: OFFICE MANAGER
Credential:
Phone: 740-266-7006