Provider Demographics
NPI:1437123981
Name:MASTERS, THOMAS R (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:MASTERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 STERRETTANIA RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3050
Mailing Address - Country:US
Mailing Address - Phone:814-833-9700
Mailing Address - Fax:814-835-4301
Practice Address - Street 1:2828 STERRETTANIA RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3050
Practice Address - Country:US
Practice Address - Phone:814-833-9700
Practice Address - Fax:814-835-4301
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005118L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA131352OtherHIGHMARK
4468622OtherAETNA
00040788601OtherUNIVERA
PA0009248520011Medicaid
253213OtherUPMC
PA0009248520011Medicaid
PAMA131352OtherHIGHMARK