Provider Demographics
NPI:1962118273
Name:MASELE, PHILBERT JOHN
Entity type:Individual
Prefix:
First Name:PHILBERT
Middle Name:JOHN
Last Name:MASELE
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 1:10560 MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7176
Mailing Address - Country:US
Mailing Address - Phone:571-419-8612
Mailing Address - Fax:703-866-8302
Practice Address - Street 1:10560 MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7114
Practice Address - Country:US
Practice Address - Phone:571-419-8612
Practice Address - Fax:703-866-8302
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant