MEDICARE: DR. ANTHONY V MASI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	013788	CT

General Provider Information

NPI Number	:	1437133154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY V MASI MD

Provider Business Mailing Address
First Line	:	4699 MAIN ST
Second Line	:	SUITE 106
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1830
Country	:	US
Telephone Number	:	203-374-8182
Fax Number	:	203-374-2626

Provider Business Practice Location Address
First Line	:	4699 MAIN ST
Second Line	:	SUITE 106
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1830
Country	:	US
Telephone Number	:	203-374-8182
Fax Number	:	203-374-2626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	08/27/2008

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