Healthcare Provider Details

I. General information

NPI: 1891955308
Provider Name (Legal Business Name): LOU RORNOLO MASTRINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 FRANKLIN ST
JOHNSTOWN PA
15905-4309
US

IV. Provider business mailing address

2151 MENOHER BLVD
JOHNSTOWN PA
15905-1628
US

V. Phone/Fax

Practice location:
  • Phone: 814-539-5340
  • Fax:
Mailing address:
  • Phone: 814-932-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number)S017717
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberOS017717
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: