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General NPI Number Information
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NPI Number | 1962663534
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Entity Type | Organization
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Legal Business Name | NICHOLAS J. MASCIOTRA MD PC
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 321 MAIN ST SUITE 4C
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City | JOHNSTOWN
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State | PA
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Zip | 15901-1632
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Country | US
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Telephone | 814-536-7725
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Fax | 814-539-3130
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Provider Business Mailing Address
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Address Line | 321 MAIN ST SUITE 4C
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City | JOHNSTOWN
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State | PA
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Zip | 15901-1632
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Country | US
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Telephone | 814-536-7725
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Fax | 814-539-3130
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS J. MASCIOTRA
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Credential | MD
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Telephone | 814-536-7725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD-016908-E
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License Number State | PA
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