Provider Demographics
NPI:1154358000
Name:MAS, OLGA M (MD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:M
Last Name:MAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:MARIA
Other - Last Name:MAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4627 NW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4357
Mailing Address - Country:US
Mailing Address - Phone:352-335-8888
Mailing Address - Fax:352-335-9427
Practice Address - Street 1:4627 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4357
Practice Address - Country:US
Practice Address - Phone:352-335-8888
Practice Address - Fax:352-335-9427
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58448208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F13018Medicare UPIN
FL14357Medicare ID - Type Unspecified