Individual
MARK MASCIOCCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3850
(508) 856-1860
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
257421
MA
2085R0202X
Diagnostic Radiology Physician
257421
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110110489A
—
MA
Enumeration date
04/22/2010
Last updated
07/26/2021
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