Provider Demographics
NPI:1285692657
Name:MASCARO, FRANK J
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:MASCARO
Suffix:
Gender:M
Credentials:
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 8000
Mailing Address - Street 2:DEPT 836
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-855-2866
Practice Address - Fax:716-855-2860
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22574822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300135206OtherRAILROAD MEDICARE
00011300701OtherUNIVERA
P00003641OtherRAILROAD MEDICARE
000526931009OtherBLUE SHIELD OF WESTERN NY
1611510OtherINDEPENDANT HEALTH
0002767500OtherUNIVERA
NYRDRA2257483OtherWORKERS COMPENSATION
000526931001OtherBLUE SHIELD OF WESTERN NY
000526931004OtherBLUE SHIELD OF WESTERN NY
NY02347060Medicaid
050812000029OtherFIDELIS
145787FFOtherPREFERRED CARE
P00003641OtherRAILROAD MEDICARE
DD4512Medicare PIN
H27056Medicare UPIN
DD2744Medicare PIN