Provider Demographics
NPI:1538390547
Name:MASTRIA, BETH MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:MASTRIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WASHINGTON ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2470
Mailing Address - Country:US
Mailing Address - Phone:508-824-7282
Mailing Address - Fax:508-824-7285
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-824-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant