Matthew Bryan Mastrodomenico (NPI# 1487944930, PAC ID# 1951600295) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PATHOLOGY.
| Nation Provider ID (NPI) | 1487944930 |
| PAC ID by PECOS | 1951600295 |
| Professional Enrollment ID | I20160720002241 |
| Full Name | Matthew Bryan Mastrodomenico |
| Organization Legal Name | THE DELTA PATHOLOGY GROUP LLC |
| Address |
2915 Missouri Ave Shreveport LA 71109-4327 |
| Phone Number | 3186218820 |
| Gender | M |
| Medical School | LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT |
| Graduation Year | 2011 |
| Primary Specialty | PATHOLOGY |
| Group Practice PAC ID | 4789639089 |
| Number of Group Practice Members | 51 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 190111 | WILLIS KNIGHTON MEDICAL CENTER |
| 190041 | CHRISTUS HEALTH SHREVEPORT - BOSSIER |
| 190144 | MINDEN MEDICAL CENTER |
| 190118 | DESOTO REGIONAL HEALTH SYSTEM |
| 191312 | CHRISTUS COUSHATTA HEALTH CARE CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2915 Missouri Ave, Shreveport, LA 71109-4327 | 3186218820 | THE DELTA PATHOLOGY GROUP LLC |
| Organization Legal Name | THE DELTA PATHOLOGY GROUP LLC |
| Physicians | 53 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nancy V Smith | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Fleurette W Abreo | Pathology | The Delta Pathology Group LLC | 1101 Medical Ctr Blvd, Marrero, LA 70072-3147 |
| William P Long | Pathology | The Delta Pathology Group LLC | 1101 Medical Ctr Blvd, Marrero, LA 70072-3147 |
| Terence T Casey | Pathology | The Delta Pathology Group LLC | 1101 Medical Ctr Blvd, Marrero, LA 70072-3147 |
| Jill A Ferguson | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Jared D Barker | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Jonathan F Koehler | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Kirtesh H Patel | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| William A Wesche | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Stephen P Blanchard | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Street Address |
2915 MISSOURI AVE |
| City | SHREVEPORT |
| State | LA |
| Zip | 71109-4327 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nancy V Smith | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Jill A Ferguson | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Jared D Barker | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Jonathan F Koehler | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Kirtesh H Patel | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| William A Wesche | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Stephen P Blanchard | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Laura R Kidd | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Thomas Nicotri Jr. | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Dale J Morvant | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David L Jordan | Optometry | 2601 Jewella Ave, Shreveport, LA 71109-3205 | |
| Richard J Blanchard Jr. | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Lee R Pankey | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Vivek K Khare | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Andrew B Sholl | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Joseph S Heard | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Bruce Herrington | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Joseph C Marrazzo | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Brian L Wilkinson | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| George K Harrison | Pathology | The Delta Pathology Group LLC | 2915 Missouri Ave, Shreveport, LA 71109-4327 |
| Find all physicians in zip 71109 | |||
| City | SHREVEPORT |
| Zip Code | 71109 |
| Specialty | PATHOLOGY |
| City + Specialty | SHREVEPORT + PATHOLOGY |
Please comment or provide details below to improve the information on Matthew Bryan Mastrodomenico.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.