Healthcare Provider Details

I. General information

NPI: 1396131066
Provider Name (Legal Business Name): JAMES RICHARD MASTRIANA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010-3121
US

IV. Provider business mailing address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010-3121
US

V. Phone/Fax

Practice location:
  • Phone: 484-337-3000
  • Fax:
Mailing address:
  • Phone: 484-337-3000
  • 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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A19532
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.013347
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS023081
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number34.013347
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: