Individual
THOMAS D MASTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6620 FLY RD, EAST SYRACUSE, NY 13057-9717
(315) 464-9390
(315) 464-6482
Mailing address
6620 FLY RD, EAST SYRACUSE, NY 13057-9717
(315) 464-9390
(315) 464-6482
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
154187
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00920549
—
NY
Enumeration date
07/20/2006
Last updated
10/21/2010
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