Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 57.014091 | OH |
NPI | 1144496936 |
---|---|
Provider Name | Dr. Tara M Mastracci |
First Address | Bratenahl, OH 44108-1169 |
Second Address | Cleveland, OH 44195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 09/03/2009 |