Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 041663 | CT |
N | 207XS0106X | Orthopaedic Hand Surgeon | MD419529 | PA |
NPI | 1275643322 |
---|---|
Provider Name | Dr. Daniel J Mastella |
First Address | Glastonbury, CT 06033-1208 |
Second Address | Glastonbury, CT 06033-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 24/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001416636 | (05) | CT |
H80309 | (02) |