Provider Demographics
NPI:1326842600
Name:MASCOLO, GRANT MATTHEW
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:MATTHEW
Last Name:MASCOLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 MLK JR BLVD # 97401
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5901
Mailing Address - Country:US
Mailing Address - Phone:541-228-8950
Mailing Address - Fax:
Practice Address - Street 1:2727 MLK JR BLVD # 97401
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5901
Practice Address - Country:US
Practice Address - Phone:541-228-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator