Leonard Vincent Mastrodomenico, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

06900R Issued in LA

Practice address

1800 Buckner St
Shreveport, LA 71101-4447

Phone

(318) 222-1149

NPI assigned

Mar 28, 2006

Last updated

Nov 1, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193875200000",
    "number": "1255391678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 DUNMORELAND CIR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711066101",
            "telephone_number": "318-222-1149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 BUCKNER ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014447",
            "telephone_number": "318-222-1149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTRODOMENICO",
        "first_name": "LEONARD",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2007-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "06900R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Massey
• Stacey Ryder Massey, MD
• Herbert B Master, MD
• Monali Master
• Ryan Gary Master, MD
• Matthew Bryan Mastrodomenico, M.D.
• John Alexander Mata, M.D.
• Maya Matabele, MD
• Rebecca Matens
• Jolene Mateo, RN

• Diagnostic Radiology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Diagnostic Radiology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.