Provider Demographics
NPI:1013909852
Name:DAVID M MASTRIANNI MD
Entity type:Organization
Organization Name:DAVID M MASTRIANNI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASTRIANNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-226-6000
Mailing Address - Street 1:PO BOX 11706
Mailing Address - Street 2:D M MASTRIANNI MD
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0706
Mailing Address - Country:US
Mailing Address - Phone:518-226-6000
Mailing Address - Fax:
Practice Address - Street 1:3 CARE LN
Practice Address - Street 2:SUITE 300
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8623
Practice Address - Country:US
Practice Address - Phone:518-226-6000
Practice Address - Fax:518-226-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA0225Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER