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Matthew Bryan Mastrodomenico, MD
Student in an Organized Health Care Education/Training Program in Shreveport, Louisiana
NPI 1487944930

Matthew Bryan Mastrodomenico is a Student in an Organized Health Care Education/Training Program based in Dallas, LA. Matthew Bryan Mastrodomenico practices in Shreveport, LA and has the professional credentials of MD. The NPI Number for Matthew Bryan Mastrodomenico is 1487944930 and holds a License No. MD.301728 (Louisiana).

The current practice location address for Matthew Bryan Mastrodomenico is 2915 Missouri Ave, Shreveport, LA and can be reached out via phone at 318-621-8820 and via fax at 318-212-4189.

Location: 2915 Missouri Ave, Shreveport, LA, 75373-1280
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1487944930
Provider Name
Matthew Bryan Mastrodomenico
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
2915 Missouri Ave, Shreveport, LA, 75373-1280
Phone Number
318-621-8820
Fax Number
318-212-4189
Provider Enumeration Date
04/17/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
13776549 01 LA CAQH
2420763 05 LA
institution
Provider Business Practice Location Address Details
Address
2915 Missouri Ave
City
Shreveport
State
Louisiana
Zip
71109-4327
Phone Number
318-621-8820
Fax Number
318-212-4189
person
Provider Business Mailing Address Details
Address
2915 Missouri Ave
City
Shreveport
State
Louisiana
Zip
71109-4327
Phone Number
318-621-8820
Fax Number
318-212-4189
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Pathology
Speciality
Anatomic Pathology & Clinical Pathology
Taxonomy
207ZP0102X
License No.
MD37690 (South Carolina)
Definition
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
MD.301728 (Louisiana)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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