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General NPI Number Information
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NPI Number | 1154953545
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Entity Type | Individual
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Provider Name | MATTHEW MASTIANO
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Gender | Male
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 12 ST PAUL DRIVE WELLSPAN NEUROSURGERY
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City | CHAMBERSBURG
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State | PA
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Zip | 17201
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Country | US
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Telephone | 717-217-6028
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MEMORY LN
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City | YORK
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State | PA
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Zip | 17402-2231
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Country | US
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Telephone | 717-851-1405
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2511
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C007902
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA062515
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA062515
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License Number State | PA
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