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General NPI Number Information
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NPI Number | 1063624468
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Entity Type | Individual
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Provider Name | TRAVIS ANTHONY MASTROIANNI D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 565 ABBOTT RD
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City | BUFFALO
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State | NY
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Zip | 14220-2039
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Country | US
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Telephone | 716-826-7000
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Fax | 716-649-9005
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Provider Business Mailing Address
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Address Line | 3040 AMSDELL RD
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City | HAMBURG
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State | NY
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Zip | 14075-5835
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Country | US
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Telephone | 716-649-9000
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Fax | 716-649-9005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 5101016519
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 14885
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 260098-1
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License Number State | NY
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