Provider Demographics
NPI:1548536352
Name:MASTRO, TIMOTHY DICKEY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DICKEY
Last Name:MASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 E NC HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2208
Mailing Address - Country:US
Mailing Address - Phone:919-544-7040
Mailing Address - Fax:919-544-7261
Practice Address - Street 1:2224 E NC HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2208
Practice Address - Country:US
Practice Address - Phone:919-544-7040
Practice Address - Fax:919-544-7261
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00251207R00000X
GA34194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine