Healthcare Provider Details

I. General information

NPI: 1134380074
Provider Name (Legal Business Name): RYAN MICHAEL MASCIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 W LANCASTER AVE
BRYN MAWR PA
19010-3805
US

IV. Provider business mailing address

1350 EDGMONT AVE STE 1500
CHESTER PA
19013-3962
US

V. Phone/Fax

Practice location:
  • Phone: 610-658-0999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102202563
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS019565
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: