Mark Mast, MD
Individual provider Active NPI Family Medicine Physician · Broadway, VA
NPI 1720166994 · NPPES record last updated May 13, 2019
Key facts
- NPI
- 1720166994
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0101230542 (VA)
- Practice address
- 13892 Timber Way
Broadway, VA 22815-3332 - Phone
- (540) 901-0800
- Fax
- (757) 578-8547
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101230542 | VA | MD | Family Medicine Physician |
Interoperability endpoints
- mmast1153479@direct.bsmhealth.org
- mmast219535@direct.sentara.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101230542 | VA | Yes |
Addresses
Primary practice location
13892 Timber Way
Broadway, VA 22815-3332
Mailing address
PO Box 1430
Harrisonburg, VA 22803-1430
Phone (540) 901-0800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720166994 | Medicaid | VA |
Other providers in Broadway, VA
- Jordan Lynn Hill
- Monica P Johns
- Javier Cesar Leal-Cruz
- Life Enrichment Services, LLC
- Mark Donald Mackay
- Nichelle Renee McDaniel Flowers
- Brenda McGillivray Smith
- Cheryl Leah Miller
- Logan Daniel Morrison
- Nelson L Showalte Ta Broadway Drug Center
All providers in Broadway, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.