Provider Demographics
NPI:1649167040
Name:MASCARINAS, MARCO TECSON (CRNA)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:TECSON
Last Name:MASCARINAS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:MARCO ALBERTO
Other - Middle Name:TECSON
Other - Last Name:MASCARINAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-618-7140
Mailing Address - Fax:
Practice Address - Street 1:800 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-618-7140
Practice Address - Fax:847-618-0228
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032523367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered