MEDICARE: THOMAS MASCIANGELO 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	207R00000X	Internal Medicine Physician	J9193	TX

General Provider Information

NPI Number	:	1629158035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MASCIANGELO MD

Provider Business Mailing Address
First Line	:	927 SHAW AVE
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77506-1430
Country	:	US
Telephone Number	:	713-982-5900
Fax Number	:	713-982-5944

Provider Business Practice Location Address
First Line	:	927 SHAW AVE
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77506-1430
Country	:	US
Telephone Number	:	713-982-5900
Fax Number	:	713-982-5944

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/29/2008

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