Healthcare Provider Details

I. General information

NPI: 1326584863
Provider Name (Legal Business Name): DR MASCARENHAS CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S 21ST STREET
EASTON PA
18042
US

IV. Provider business mailing address

175 S 21ST ST
EASTON PA
18042-3835
US

V. Phone/Fax

Practice location:
  • Phone: 610-253-4898
  • Fax: 610-253-6355
Mailing address:
  • Phone: 610-253-4898
  • Fax: 610-253-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD051153L
License Number StatePA

VIII. Authorized Official

Name: DR. DANIELL A N MASCARENHAS
Title or Position: OWNER
Credential: MD
Phone: 610-253-4898