Judith M. Mascolo, MD, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036592 Issued in CT

Legal business name

JUDITH M. MASCOLO, MD, LLC

Practice address

639 Park Rd
Ste 100
West Hartford, CT 06107-3443

Phone

(860) 233-4600

Fax

(860) 233-4604

NPI assigned

Sep 14, 2007

Last updated

Apr 28, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Judith M Mascolo, M.D.NPI 1972641801

Title

Owner

Phone

(860) 233-4600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Judith M Mascolo, M.D.

  • Family Medicine Physician
  • West Hartford, CT
  • NPI 1972641801
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398643200000",
    "number": "1043406812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 PARK RD STE 100",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061073443",
            "telephone_number": "860-233-4600",
            "fax_number": "860-233-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 PARK RD",
            "address_2": "STE 100",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061073443",
            "telephone_number": "860-233-4600",
            "fax_number": "860-233-4604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDITH M. MASCOLO, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-14",
        "last_updated": "2014-04-28",
        "status": "A",
        "authorized_official_last_name": "MASCOLO",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-233-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "036592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.