Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | C1-0001517 | DE |
N | 207NS0135X | Procedural Dermatology | C10001517 | DE |
NPI | 1225128614 |
---|---|
Provider Name | Elizabeth F,. Masten |
First Address | Milford, DE 19963-2917 |
Second Address | Milford, DE 19963-2917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 20/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B66298 | (02) | DE |