Provider Demographics
NPI:1104895390
Name:MASIELLO, JOHN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:MASIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862811
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2811
Mailing Address - Country:US
Mailing Address - Phone:913-754-0467
Mailing Address - Fax:913-341-5797
Practice Address - Street 1:711 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6058
Practice Address - Country:US
Practice Address - Phone:913-754-0467
Practice Address - Fax:913-341-5797
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75034207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050066602OtherRAILROAD MEDICARE
FL254304400Medicaid
FL43374OtherBCBS
FL050066602OtherRAILROAD MEDICARE
FL43374AMedicare PIN