Organization
KEVIN J MASTERSON MD INC
Active
Other names
Kevin J Masterson MD
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J MASTERSON MD (PRESIDENT)
(440) 356-5477
Entity
Organization
Contact information
Practice address
20455 LORAIN RD, SUITE 102, FAIRVIEW PARK, OH 44126-3529
(440) 356-5477
(440) 356-5885
Mailing address
20455 LORAIN RD., SUITE 102, FAIRVIEW PARK, OH 44126-3529
(440) 356-5477
(440) 356-5885
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-04-5048-M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0481554
—
OH
Enumeration date
02/08/2012
Last updated
02/08/2012
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