Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | C2-0012667 | DE |
N | 111NI0900X | Internist | C2-0012667 | DE |
Y | 207R00000X | Internist | OS-006313L | PA |
Y | 111NI0900X | Internist | OS-006313L | PA |
N | 207RG0300X | Geriatric Medicine | C2-0012667 | DE |
N | 207RG0300X | Geriatric Medicine | OS-006313L | PA |
NPI | 1104910140 |
---|---|
Provider Name | Daniel D Mast |
First Address | Willow Street, PA 17584-8908 |
Second Address | Lancaster, PA 17602-2288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 04/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015871020009 | (05) | PA |
F33537 | (02) | PA |