Provider Demographics
NPI:1194793042
Name:MASCOLO, MARIA C (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:MASCOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14417
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1417
Mailing Address - Country:US
Mailing Address - Phone:912-629-2290
Mailing Address - Fax:912-629-2291
Practice Address - Street 1:131 SILVERWOOD CT
Practice Address - Street 2:SUITE 100
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5131
Practice Address - Country:US
Practice Address - Phone:912-826-3927
Practice Address - Fax:912-826-3931
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA052469207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA487007710BMedicaid
GA290015487OtherRAILROAD MEDICARE
GA487007710BMedicaid
GA11BDWLVMedicare PIN