Provider Demographics
NPI:1154416972
Name:MASSERANO, MARIO (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:MASSERANO
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 1:1015 MIRAMAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:561-276-1125
Mailing Address - Fax:561-666-4795
Practice Address - Street 1:1015 MIRAMAR DRIVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6927
Practice Address - Country:US
Practice Address - Phone:561-276-1125
Practice Address - Fax:561-276-7698
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1831308543OtherMEDICARE GROUP NPI
FL1831308543OtherMEDICARE GROUP NPI
FLF51232Medicare UPIN